MEDICARE: MODERN OPTIKA ,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	156FX1800X	Optician	0071631	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	:	1861442022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN OPTIKA ,INC

Provider Business Mailing Address
First Line	:	453 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1803
Country	:	US
Telephone Number	:	718-336-1060
Fax Number	:	718-336-0113

Provider Business Practice Location Address
First Line	:	453 KINGS HWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-1803
Country	:	US
Telephone Number	:	718-336-1060
Fax Number	:	718-336-0113

Authorized Official
Title or Position	:	OPTICIAN
Name	:	MR. LEONARD DONDE
Credential	:	OD
Telephone Number	:	718-336-1060

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	12/11/2007

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Directions to “MODERN OPTIKA ,INC ” Practice Location

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