MEDICARE: LAURENT MADTEOSSIAN 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	008222	NY

General Provider Information

NPI Number	:	1699171801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURENT MADTEOSSIAN OD

Provider Business Mailing Address
First Line	:	115 S 2ND ST APT 17
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11249-5206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 S 2ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11249-5206
Country	:	US
Telephone Number	:	857-869-6224
Fax Number	:

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

Provider Enumeration Date	:	11/15/2014
Last Update Date	:	11/15/2014

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