MEDICARE: DR. IRIS ROBERTS 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	T-005377	NY

General Provider Information

NPI Number	:	1851556294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IRIS ROBERTS O.D.

Provider Business Mailing Address
First Line	:	29 BERWICK RD
Second Line	:
City	:	HEWLETT
State	:	NY
Zip	:	11557-1531
Country	:	US
Telephone Number	:	718-267-1260
Fax Number	:

Provider Business Practice Location Address
First Line	:	3250 VERNON BLVD
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11106-4927
Country	:	US
Telephone Number	:	718-267-1260
Fax Number	:

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

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	07/24/2008

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