MEDICARE: MR. LOUIS SOLOMON OPTICIAN

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	006929	NY

General Provider Information

NPI Number	:	1881999522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LOUIS SOLOMON OPTICIAN

Provider Business Mailing Address
First Line	:	240 PAGE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1170
Country	:	US
Telephone Number	:	718-554-4762
Fax Number	:	347-983-4456

Provider Business Practice Location Address
First Line	:	240 PAGE AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10307-1170
Country	:	US
Telephone Number	:	718-554-4762
Fax Number	:	347-983-4456

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

Provider Enumeration Date	:	01/11/2011
Last Update Date	:	02/21/2013

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Directions to “ MR. LOUIS SOLOMON OPTICIAN” Practice Location

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