MEDICARE: RIDGEBORO OPTICIANS

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	156FX1800X	Optician	005006-1	NY

General Provider Information

NPI Number	:	1790943462
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGEBORO OPTICIANS

Provider Business Mailing Address
First Line	:	8009 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4003
Country	:	US
Telephone Number	:	718-748-0513
Fax Number	:	718-748-0822

Provider Business Practice Location Address
First Line	:	8009 5TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4003
Country	:	US
Telephone Number	:	718-748-0513
Fax Number	:	718-748-0822

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. JOSEPH BERNARD SOLLECITO
Credential	:
Telephone Number	:	718-748-0513

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	06/06/2008

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Directions to “RIDGEBORO OPTICIANS ” Practice Location

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