MEDICARE: STYLE EYES1 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1669948840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STYLE EYES1 INC

Provider Business Mailing Address
First Line	:	1005 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-5006
Country	:	US
Telephone Number	:	718-942-5957
Fax Number	:	718-942-5953

Provider Business Practice Location Address
First Line	:	1005 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-5006
Country	:	US
Telephone Number	:	718-942-5957
Fax Number	:	718-942-5953

Authorized Official
Title or Position	:	MANAGEMENTS
Name	:	MS. MARORIE TONEY
Credential	:
Telephone Number	:	718-942-5957

Provider Enumeration Date	:	10/16/2018
Last Update Date	:	10/16/2018

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