MEDICARE: VINCENT A WESOLOWSKI O.D.

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	TUV 003515-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	P3677257	OTHER	OXFORD
2	7937476	OTHER	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801985155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT A WESOLOWSKI O.D.

Provider Business Mailing Address
First Line	:	2630 CROPSEY AVE
Second Line	:	16 H
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6757
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8949 BAY PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-6437
Country	:	US
Telephone Number	:	718-372-1212
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/20/2012

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