MEDICARE: DR. JOANNE ECONOPOULY 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	VUT006061	NY

General Provider Information

NPI Number	:	1609991645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOANNE ECONOPOULY O.D.

Provider Business Mailing Address
First Line	:	9001 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7938
Country	:	US
Telephone Number	:	718-458-8500
Fax Number	:	718-424-3366

Provider Business Practice Location Address
First Line	:	9001 ROOSEVELT AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7938
Country	:	US
Telephone Number	:	718-458-9761
Fax Number	:	718-424-3366

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	09/13/2022

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