MEDICARE: OPTICAL LATINA

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	T5611-1	NY

General Provider Information

NPI Number	:	1588709042
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTICAL LATINA

Provider Business Mailing Address
First Line	:	5418 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3113
Country	:	US
Telephone Number	:	718-439-1300
Fax Number	:	718-439-1613

Provider Business Practice Location Address
First Line	:	5418 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-3113
Country	:	US
Telephone Number	:	718-439-1300
Fax Number	:	718-439-1613

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID CLAUDIO
Credential	:
Telephone Number	:	718-439-1300

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	08/22/2020

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Directions to “OPTICAL LATINA ” Practice Location

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