MEDICARE: DR. EDWARD ALEXANDER LACORTE 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	007791-1	NY

General Provider Information

NPI Number	:	1568759850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD ALEXANDER LACORTE O.D.

Provider Business Mailing Address
First Line	:	220 MANHATTAN AVE
Second Line	:	APT 4K
City	:	NEW YORK
State	:	NY
Zip	:	10025-2623
Country	:	US
Telephone Number	:	607-316-2846
Fax Number	:

Provider Business Practice Location Address
First Line	:	811 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-5202
Country	:	US
Telephone Number	:	718-924-2552
Fax Number	:

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

Provider Enumeration Date	:	07/07/2011
Last Update Date	:	09/11/2020

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