MEDICARE: SUNSHINE OPTICAL, INC.

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	4400	NY
2	156FX1800X	Optician	5410	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	:	1447404587
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUNSHINE OPTICAL, INC.

Provider Business Mailing Address
First Line	:	699A OLD COUNTRY RD
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-4613
Country	:	US
Telephone Number	:	631-271-3520
Fax Number	:	631-271-3706

Provider Business Practice Location Address
First Line	:	699A OLD COUNTRY RD
Second Line	:
City	:	HUNTINGTON STATION
State	:	NY
Zip	:	11746-4613
Country	:	US
Telephone Number	:	631-271-3520
Fax Number	:	631-271-3706

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JAMES DECICCO
Credential	:	OPT
Telephone Number	:	631-271-3520

Provider Enumeration Date	:	11/14/2008
Last Update Date	:	08/01/2015

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Directions to “SUNSHINE OPTICAL, INC. ” Practice Location

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