MEDICARE: NY OPTIX 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	332H00000X	Eyewear Supplier	007414	NY

General Provider Information

NPI Number	:	1497992069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY OPTIX LLC

Provider Business Mailing Address
First Line	:	1823 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5308
Country	:	US
Telephone Number	:	718-377-5649
Fax Number	:	718-377-1935

Provider Business Practice Location Address
First Line	:	1823 AVENUE M
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-5308
Country	:	US
Telephone Number	:	718-377-5649
Fax Number	:	718-377-1935

Authorized Official
Title or Position	:	OWNER
Name	:	MR. YAAKOV SHEINHOUSE
Credential	:	LICENSED OPTICIAN
Telephone Number	:	718-377-5649

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	01/19/2009

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