MEDICARE: ELITEEYE OPTICAL

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

General Provider Information

NPI Number	:	1629709688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITEEYE OPTICAL

Provider Business Mailing Address
First Line	:	1234 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4102
Country	:	US
Telephone Number	:	718-374-5498
Fax Number	:	718-374-5669

Provider Business Practice Location Address
First Line	:	1234 AVENUE U
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-4102
Country	:	US
Telephone Number	:	718-374-5498
Fax Number	:	718-374-5669

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HOUKUN CHEN
Credential	:	OPTICIAN
Telephone Number	:	646-678-8020

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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Directions to “ELITEEYE OPTICAL ” Practice Location

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