MEDICARE: MR. ROBERT ALLEN SMITH 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	5341	NY

General Provider Information

NPI Number	:	1902559198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT ALLEN SMITH OPTICIAN

Provider Business Mailing Address
First Line	:	13 E MAIN ST
Second Line	:
City	:	OYSTER BAY
State	:	NY
Zip	:	11771-2405
Country	:	US
Telephone Number	:	516-922-2533
Fax Number	:	516-922-8227

Provider Business Practice Location Address
First Line	:	13 E MAIN ST
Second Line	:
City	:	OYSTER BAY
State	:	NY
Zip	:	11771-2405
Country	:	US
Telephone Number	:	516-922-2533
Fax Number	:	516-922-8227

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

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	01/28/2022

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