MEDICARE: DR. BRAD C GOLLINGER O.D.

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	VUT005741	NY

General Provider Information

NPI Number	:	1699779678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRAD C GOLLINGER O.D.

Provider Business Mailing Address
First Line	:	91 LAKES RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-2613
Country	:	US
Telephone Number	:	845-783-1224
Fax Number	:	845-783-3905

Provider Business Practice Location Address
First Line	:	91 LAKES RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-2613
Country	:	US
Telephone Number	:	845-783-1224
Fax Number	:	845-783-3905

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	10/08/2010

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