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NPI Code Detail

MEDICARE: DR. MARIA J BUSTAMANTE OD

MEDICARE: DR. MARIA J BUSTAMANTE 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
1152W00000XOptometristTUV009808-01NY

General Provider Information

NPI Number : 1750060067
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIA J BUSTAMANTE OD
Provider Business Mailing Address
First Line : 1258 6TH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10020-1511
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1258 6TH AVE
Second Line :
City : NEW YORK
State : NY
Zip : 10020-1511
Country : US
Telephone Number : 503-705-7755
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2023
Last Update Date : 07/13/2023

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Directions to “ DR. MARIA J BUSTAMANTE OD” Practice Location

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