MEDICARE: MR. FREDRIC BARRY RAPPS OPHTHALMIC DISPENSER

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	156FX1800X	Optician	3934	NY

General Provider Information

NPI Number	:	1619011822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FREDRIC BARRY RAPPS OPHTHALMIC DISPENSER

Provider Business Mailing Address
First Line	:	451 SPRUCE LN
Second Line	:
City	:	EAST MEADOW
State	:	NY
Zip	:	11554-3705
Country	:	US
Telephone Number	:	516-481-1132
Fax Number	:

Provider Business Practice Location Address
First Line	:	2453 JERICHO TPKE
Second Line	:
City	:	GARDEN CITY PARK
State	:	NY
Zip	:	11040-4710
Country	:	US
Telephone Number	:	516-746-3836
Fax Number	:

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

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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