MEDICARE: GENA KOCHIN OD

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	V005778	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	:	1548263833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENA KOCHIN OD

Provider Business Mailing Address
First Line	:	278 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4003
Country	:	US
Telephone Number	:	718-646-2200
Fax Number	:	718-646-6623

Provider Business Practice Location Address
First Line	:	278 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4003
Country	:	US
Telephone Number	:	718-646-2200
Fax Number	:	718-646-6623

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/08/2010

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