MEDICARE: BROOKHAVEN OPTICIANS INC.

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	332H00000X	Eyewear Supplier	C0058551	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821115155
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKHAVEN OPTICIANS INC.

Provider Business Mailing Address
First Line	:	79 E MAIN ST STE D
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2867
Country	:	US
Telephone Number	:	631-265-5767
Fax Number	:	631-265-9624

Provider Business Practice Location Address
First Line	:	79 E MAIN ST STE D
Second Line	:
City	:	SMITHTOWN
State	:	NY
Zip	:	11787-2867
Country	:	US
Telephone Number	:	631-265-5767
Fax Number	:	631-265-9624

Authorized Official
Title or Position	:	OPTICIAN
Name	:	PAUL MASTROROCCO
Credential	:
Telephone Number	:	631-265-5767

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	06/01/2026

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