MEDICARE: THE OPTICAL CENTER @ OPHTHALMOLOGY ASSOCIATION OF BAY RIDGE INC.

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	4038	NY

General Provider Information

NPI Number	:	1659599801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE OPTICAL CENTER @ OPHTHALMOLOGY ASSOCIATION OF BAY RIDGE INC.

Provider Business Mailing Address
First Line	:	8310 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4511
Country	:	US
Telephone Number	:	718-680-2020
Fax Number	:	718-680-5771

Provider Business Practice Location Address
First Line	:	8310 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4511
Country	:	US
Telephone Number	:	718-680-2020
Fax Number	:	718-680-5771

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN GANZ
Credential	:	OD
Telephone Number	:	718-680-2020

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	04/21/2009

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