MEDICARE: EYE GOT U OF BROOKLYN, 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	332H00000X	Eyewear Supplier	007740	NY

General Provider Information

NPI Number	:	1710252507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE GOT U OF BROOKLYN, INC

Provider Business Mailing Address
First Line	:	1710 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-6602
Country	:	US
Telephone Number	:	718-323-6410
Fax Number	:	718-323-6375

Provider Business Practice Location Address
First Line	:	1710 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-6602
Country	:	US
Telephone Number	:	718-323-6410
Fax Number	:	718-323-6375

Authorized Official
Title or Position	:	MANAGER
Name	:	LEIGH KOTCH
Credential	:
Telephone Number	:	718-323-6410

Provider Enumeration Date	:	03/13/2012
Last Update Date	:	03/13/2012

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