MEDICARE: DR. RICHARD S. WURZEL OD

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	VUT003937	NY

General Provider Information

NPI Number	:	1669477162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD S. WURZEL OD

Provider Business Mailing Address
First Line	:	6 DARA CT
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-1428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 DARA CT
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-1428
Country	:	US
Telephone Number	:	845-783-0026
Fax Number	:

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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