MEDICARE: A&M OPTOMETRIC GROUP, 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	152W00000X	Optometrist	006846	NY
2	152W00000X	Optometrist	006848	NY

General Provider Information

NPI Number	:	1528156718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&M OPTOMETRIC GROUP, LLC

Provider Business Mailing Address
First Line	:	1910 AVENUE U
Second Line	:	1ST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3906
Country	:	US
Telephone Number	:	718-759-6979
Fax Number	:	718-759-6981

Provider Business Practice Location Address
First Line	:	1910 AVENUE U
Second Line	:	1ST FLOOR
City	:	BROOKLYN
State	:	NY
Zip	:	11229-3906
Country	:	US
Telephone Number	:	718-759-6979
Fax Number	:	718-759-6981

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ALEKSANDRA ZLOTNIK
Credential	:	O.D.
Telephone Number	:	718-759-6979

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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