MEDICARE: ROYAL OPTICAL

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	302F00000X	Exclusive Provider Organization	008630	NY

General Provider Information

NPI Number	:	1407185283
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYAL OPTICAL

Provider Business Mailing Address
First Line	:	328 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-3641
Country	:	US
Telephone Number	:	212-663-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	328 W 125TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-3641
Country	:	US
Telephone Number	:	212-663-2020
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPTICIAN
Name	:	EDWARD BANGIYEV
Credential	:
Telephone Number	:	347-475-6692

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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Directions to “ROYAL OPTICAL ” Practice Location

Language	Start Address	Practice Location

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