MEDICARE: MR. CARL ROTHMAN FNAO

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	156FC0801X	Contact Lens Fitter	C4579	NY
2	156FX1800X	Optician	C4579	NY

General Provider Information

NPI Number	:	1760506760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARL ROTHMAN FNAO

Provider Business Mailing Address
First Line	:	2529 KERRY LN
Second Line	:
City	:	BELLMORE
State	:	NY
Zip	:	11710-5103
Country	:	US
Telephone Number	:	516-781-6752
Fax Number	:	516-781-6752

Provider Business Practice Location Address
First Line	:	21411 73RD AVE
Second Line	:
City	:	OAKLAND GARDENS
State	:	NY
Zip	:	11364-2947
Country	:	US
Telephone Number	:	718-225-5533
Fax Number	:	718-225-5803

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

Provider Enumeration Date	:	03/17/2007
Last Update Date	:	09/11/2025

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