MEDICARE: D.S. OPTOMETRIC SERVICES PC

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	:	1881132694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D.S. OPTOMETRIC SERVICES PC

Provider Business Mailing Address
First Line	:	7415 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5614
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7415 18TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-5614
Country	:	US
Telephone Number	:	718-232-3907
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DIANA SIMKHOVICH
Credential	:	O.D.
Telephone Number	:	718-232-3907

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	02/01/2017

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