MEDICARE: BEAUTIFUL EYES OPTICAL CORP

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	6193	NY

General Provider Information

NPI Number	:	1851576409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAUTIFUL EYES OPTICAL CORP

Provider Business Mailing Address
First Line	:	2748 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4658
Country	:	US
Telephone Number	:	718-979-2200
Fax Number	:

Provider Business Practice Location Address
First Line	:	2748 HYLAN BLVD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-4658
Country	:	US
Telephone Number	:	718-979-2200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. LILY BESPALAJA
Credential	:
Telephone Number	:	718-979-2200

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	02/19/2010

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Directions to “BEAUTIFUL EYES OPTICAL CORP ” Practice Location

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