MEDICARE: NOSTRAND OPTICAL, 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	152W00000X	Optometrist	TUV0056301	NY
2	156FX1800X	Optician	007691-1	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	:	1831275510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOSTRAND OPTICAL, INC

Provider Business Mailing Address
First Line	:	1018C NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3509
Country	:	US
Telephone Number	:	718-773-9391
Fax Number	:	718-773-9391

Provider Business Practice Location Address
First Line	:	1018C NOSTRAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11225-3509
Country	:	US
Telephone Number	:	718-773-9391
Fax Number	:	718-773-9391

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. IGOR VALERY SUPITSKIY
Credential	:	OPTICIAN
Telephone Number	:	718-773-9391

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	09/11/2025

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Directions to “NOSTRAND OPTICAL, INC ” Practice Location

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