MEDICARE: LENORE SUSAN KATZ

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	4296	NY

General Provider Information

NPI Number	:	1669750295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LENORE SUSAN KATZ

Provider Business Mailing Address
First Line	:	90-15 QUEENS BLVD.
Second Line	:	QUEENS CENTER MALL
City	:	ELMHURST
State	:	NY
Zip	:	11373
Country	:	US
Telephone Number	:	718-592-5200
Fax Number	:	718-592-7902

Provider Business Practice Location Address
First Line	:	9015 QUEENS BLVD
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-4900
Country	:	US
Telephone Number	:	718-592-5200
Fax Number	:	718-592-7902

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

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	08/01/2011

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Directions to “ LENORE SUSAN KATZ ” Practice Location

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