MEDICARE: VIP OPTICAL, INC.

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	156FX1800X	Optician	008486	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	:	1548496797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIP OPTICAL, INC.

Provider Business Mailing Address
First Line	:	1916 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3104
Country	:	US
Telephone Number	:	718-621-1624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1916 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3104
Country	:	US
Telephone Number	:	718-621-1624
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LENNY TEMIRYAYEV
Credential	:	O.D.
Telephone Number	:	718-621-1624

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	08/26/2011

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Directions to “VIP OPTICAL, INC. ” Practice Location

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