MEDICARE: MIRKIN VISION CARE PC

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	332BC3200X	Customized Equipment (DME)	VUT004688	NY
2	332H00000X	Eyewear Supplier	VUT004688	NY
3	152W00000X	Optometrist	004688	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417920042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIRKIN VISION CARE PC

Provider Business Mailing Address
First Line	:	253 BEACH 116TH ST
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2102
Country	:	US
Telephone Number	:	718-634-0005
Fax Number	:	718-474-2003

Provider Business Practice Location Address
First Line	:	253 BEACH 116TH ST
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2102
Country	:	US
Telephone Number	:	718-634-0005
Fax Number	:	718-474-2003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PROF. DANIEL S MIRKIN
Credential	:	O.D.
Telephone Number	:	718-634-0005

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	03/29/2010

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Directions to “MIRKIN VISION CARE PC ” Practice Location

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