MEDICARE: EYECON OPTICAL INC

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

General Provider Information

NPI Number	:	1376001859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYECON OPTICAL INC

Provider Business Mailing Address
First Line	:	8009 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4003
Country	:	US
Telephone Number	:	718-748-0513
Fax Number	:

Provider Business Practice Location Address
First Line	:	8009 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4003
Country	:	US
Telephone Number	:	718-748-0513
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JOHN D DEMETRIADES
Credential	:	R.PH.
Telephone Number	:	917-881-2910

Provider Enumeration Date	:	03/04/2019
Last Update Date	:	03/04/2019

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Directions to “EYECON OPTICAL INC ” Practice Location

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