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NPI Code Detail

MEDICARE: CANARSIE OPTOMETRY PC

MEDICARE: CANARSIE OPTOMETRY PC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1700491842
Entity Type Code : Organization
Provider Name (Legal Business Name) : CANARSIE OPTOMETRY PC
Provider Business Mailing Address
First Line : 1761 ROCKAWAY PKWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4825
Country : US
Telephone Number : 718-513-9666
Fax Number :
Provider Business Practice Location Address
First Line : 1761 ROCKAWAY PKWY
Second Line :
City : BROOKLYN
State : NY
Zip : 11236-4825
Country : US
Telephone Number : 718-513-9666
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. LEONARD FUZAYLOV
Credential : OD
Telephone Number : 718-513-9666
Provider Enumeration Date : 09/15/2020
Last Update Date : 09/15/2020

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Directions to “CANARSIE OPTOMETRY PC ” Practice Location

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