MEDICARE: MR. JASON SHEN OPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	0085391	NY

General Provider Information

NPI Number	:	1356588404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JASON SHEN OPT

Provider Business Mailing Address
First Line	:	47 MOTT ST APT 45
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10013-5014
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	458 3RD AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6027
Country	:	US
Telephone Number	:	212-696-5990
Fax Number	:	212-696-5990

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	12/14/2009

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Directions to “ MR. JASON SHEN OPT” Practice Location

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