MEDICARE: GRAND VISION OPTOMETRY P.C.

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	TUV007138	NY

General Provider Information

NPI Number	:	1629374186
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND VISION OPTOMETRY P.C.

Provider Business Mailing Address
First Line	:	1316 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1904
Country	:	US
Telephone Number	:	718-376-6177
Fax Number	:	718-376-6514

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. BORIS KAPELNIK
Credential	:	O.D.
Telephone Number	:	718-367-6177

Provider Enumeration Date	:	02/01/2011
Last Update Date	:	02/01/2011

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