MEDICARE: LENSMASTERS, 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	261QP2300X	Primary Care Clinic/Center

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	:	1487628020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LENSMASTERS, INC

Provider Business Mailing Address
First Line	:	11502 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1902
Country	:	US
Telephone Number	:	718-835-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11502 LIBERTY AVE
Second Line	:
City	:	SOUTH RICHMOND HILL
State	:	NY
Zip	:	11419-1902
Country	:	US
Telephone Number	:	718-835-8000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. IGOR SLONY
Credential	:	OPTICIAN
Telephone Number	:	718-835-8000

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	05/01/2008

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Directions to “LENSMASTERS, INC ” Practice Location

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