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NPI Code Detail

MEDICARE: DR. NICKOLAS GEORGE VLANTIS O.D.

MEDICARE: DR. NICKOLAS GEORGE VLANTIS O.D.
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
1152W00000XOptometristTUV005473-1NY

General Provider Information

NPI Number : 1417162546
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICKOLAS GEORGE VLANTIS O.D.
Provider Business Mailing Address
First Line : 16005 23RD AVE
Second Line :
City : WHITESTONE
State : NY
Zip : 11357-3938
Country : US
Telephone Number : 718-357-5458
Fax Number :
Provider Business Practice Location Address
First Line : 5572 BROADWAY
Second Line :
City : BRONX
State : NY
Zip : 10463-5216
Country : US
Telephone Number : 718-884-4297
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2007
Last Update Date : 07/08/2007

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