MEDICARE: TELEOPTOMETRIC SERVICE, P.C.

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

General Provider Information

NPI Number	:	1558297713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELEOPTOMETRIC SERVICE, P.C.

Provider Business Mailing Address
First Line	:	1 VERMONT DR
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1128
Country	:	US
Telephone Number	:	380-223-3412
Fax Number	:

Provider Business Practice Location Address
First Line	:	8435 WALBROOK DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-3115
Country	:	US
Telephone Number	:	380-223-3412
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	SUSAN L CHRISTOPHER-BRAND
Credential	:
Telephone Number	:	703-314-8795

Provider Enumeration Date	:	06/23/2026
Last Update Date	:	06/23/2026

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