MEDICARE: DR. ROBERT J ANCONA 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	VUT 005837	NY
2	152WC0802X	Corneal and Contact Management Optometrist	VUT 005837	NY
3	152WL0500X	Low Vision Rehabilitation Optometrist	VUT 005837	NY
4	152WP0200X	Pediatric Optometrist	VUT 005837	NY
5	152WS0006X	Sports Vision Optometrist	VUT 005837	NY
6	152WV0400X	Vision Therapy Optometrist	VUT 005837	NY
7	152WX0102X	Occupational Vision Optometrist	VUT005837	NY
8	152WC0802X	Corneal and Contact Management Optometrist	TUV005837-1	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	:	1518946243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT J ANCONA O.D.

Provider Business Mailing Address
First Line	:	84 FRONT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1004
Country	:	US
Telephone Number	:	718-422-7800
Fax Number	:	718-422-7887

Provider Business Practice Location Address
First Line	:	84 FRONT ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-1004
Country	:	US
Telephone Number	:	718-422-7800
Fax Number	:	718-422-7887

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	09/15/2009

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