MEDICARE: WEST SIDE EYE SPECS LLC

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	:	1679031413
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SIDE EYE SPECS LLC

Provider Business Mailing Address
First Line	:	2165 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6603
Country	:	US
Telephone Number	:	212-877-2980
Fax Number	:

Provider Business Practice Location Address
First Line	:	2165 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10024-6603
Country	:	US
Telephone Number	:	212-877-2980
Fax Number	:	212-877-0549

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DAVID HYDE
Credential	:	OD
Telephone Number	:	212-877-2980

Provider Enumeration Date	:	03/12/2019
Last Update Date	:	03/12/2019

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Directions to “WEST SIDE EYE SPECS LLC ” Practice Location

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