MEDICARE: ALAN RICHARD MINKOFF O.D.

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	TUV003471-1	NY

General Provider Information

NPI Number	:	1487718631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN RICHARD MINKOFF O.D.

Provider Business Mailing Address
First Line	:	6806 BAY PARKWAY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5524
Country	:	US
Telephone Number	:	718-236-4352
Fax Number	:	718-837-0783

Provider Business Practice Location Address
First Line	:	6806 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5524
Country	:	US
Telephone Number	:	718-236-4352
Fax Number	:	718-837-0783

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	11/25/2008

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