MEDICARE: EYES AT A GLANCE 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	152W00000X	Optometrist

General Provider Information

NPI Number	:	1427577899
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES AT A GLANCE LLC

Provider Business Mailing Address
First Line	:	1357 BROADWAY FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3618
Country	:	US
Telephone Number	:	347-291-3831
Fax Number	:

Provider Business Practice Location Address
First Line	:	1357 BROADWAY FL 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3618
Country	:	US
Telephone Number	:	347-291-3831
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. NYEGYPT INNISS
Credential	:
Telephone Number	:	347-627-5081

Provider Enumeration Date	:	09/16/2017
Last Update Date	:	07/21/2022

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