MEDICARE: RUPAL KAKKAD

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	TUV008315	NY

General Provider Information

NPI Number	:	1801270780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUPAL KAKKAD

Provider Business Mailing Address
First Line	:	150 5TH AVE
Second Line	:	OPTOMETRIC EYE SERVICES LLC
City	:	NEW YORK
State	:	NY
Zip	:	10011-4311
Country	:	US
Telephone Number	:	212-352-9022
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 5TH AVE
Second Line	:	OPTOMETRIC EYE SERVICES LLC
City	:	NEW YORK
State	:	NY
Zip	:	10011-4311
Country	:	US
Telephone Number	:	212-352-9022
Fax Number	:

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

Provider Enumeration Date	:	07/10/2015
Last Update Date	:	07/10/2015

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Directions to “ RUPAL KAKKAD ” Practice Location

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