MEDICARE: LEVY'S VISION CENTER LLC

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	:	1407510191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEVY'S VISION CENTER LLC

Provider Business Mailing Address
First Line	:	4021 13TH AVE APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3539
Country	:	US
Telephone Number	:	718-633-4377
Fax Number	:	718-633-4378

Provider Business Practice Location Address
First Line	:	4021 13TH AVE APT 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3539
Country	:	US
Telephone Number	:	718-633-4377
Fax Number	:	718-633-4378

Authorized Official
Title or Position	:	OWNER
Name	:	MOSHE BADALOV
Credential	:
Telephone Number	:	718-633-4377

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	10/28/2021

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