MEDICARE: NAGWA IBRAHIM 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
1	152W00000X	Optometrist	TUV008651	NY

General Provider Information

NPI Number	:	1790297638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAGWA IBRAHIM OD

Provider Business Mailing Address
First Line	:	1 RITZ PL
Second Line	:
City	:	LINDENHURST
State	:	NY
Zip	:	11757-1833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5171 KINGS PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5218
Country	:	US
Telephone Number	:	718-951-9800
Fax Number	:	718-252-3736

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

Provider Enumeration Date	:	11/01/2017
Last Update Date	:	11/09/2022

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