MEDICARE: MASUDA HOSSAIN 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	TUV007555-1	NY

General Provider Information

NPI Number	:	1831401629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASUDA HOSSAIN O.D.

Provider Business Mailing Address
First Line	:	570 19TH STREET
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-1011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 CHURCH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3305
Country	:	US
Telephone Number	:	718-871-5152
Fax Number	:

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	03/17/2018

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