MEDICARE: EYES ON LIBERTY

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

General Provider Information

NPI Number	:	1861855496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYES ON LIBERTY

Provider Business Mailing Address
First Line	:	1086 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2923
Country	:	US
Telephone Number	:	718-277-1200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1086 LIBERTY AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11208-2923
Country	:	US
Telephone Number	:	718-277-1200
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	ANDREY KESLER
Credential	:
Telephone Number	:	718-277-1200

Provider Enumeration Date	:	03/31/2016
Last Update Date	:	03/31/2016

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Directions to “EYES ON LIBERTY ” Practice Location

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