MEDICARE: NEW VISION OPHTHALMOLOGY 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	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1437262714
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW VISION OPHTHALMOLOGY PC

Provider Business Mailing Address
First Line	:	PO BOX 462
Second Line	:
City	:	ROSLYN HEIGHTS
State	:	NY
Zip	:	11577
Country	:	US
Telephone Number	:	718-265-9900
Fax Number	:	718-265-9219

Provider Business Practice Location Address
First Line	:	2327 83RD ST
Second Line	:	SUITE B
City	:	BROOKLYN
State	:	NY
Zip	:	11214-2750
Country	:	US
Telephone Number	:	718-265-9900
Fax Number	:	718-265-9219

Authorized Official
Title or Position	:	PC HOLDER
Name	:	LEON FUTORAN
Credential	:	MD
Telephone Number	:	718-265-9900

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	11/14/2007

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