MEDICARE: ALLA ZLOTINA 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	TUV 006703	NY

General Provider Information

NPI Number	:	1598707887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLA ZLOTINA O.D.

Provider Business Mailing Address
First Line	:	273 ELTINGVILLE BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10312-2447
Country	:	US
Telephone Number	:	917-554-1765
Fax Number	:

Provider Business Practice Location Address
First Line	:	3511 QUENTIN RD
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4230
Country	:	US
Telephone Number	:	718-377-1021
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	12/13/2013

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