MEDICARE: INDELICATO OPTICIANS 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	332B00000X	Durable Medical Equipment & Medical Supplies	C003893-1	NY

General Provider Information

NPI Number	:	1679639231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDELICATO OPTICIANS INC.

Provider Business Mailing Address
First Line	:	6819 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6819 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-4416
Country	:	US
Telephone Number	:	718-236-6090
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. VINCENT INDELICATO
Credential	:
Telephone Number	:	718-236-6090

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	02/17/2016

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