MEDICARE: DR. AMY LYNN PORAN OD

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	TUV005876	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	:	1902943244
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY LYNN PORAN OD

Provider Business Mailing Address
First Line	:	552 HENRY ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-2801
Country	:	US
Telephone Number	:	718-852-9871
Fax Number	:	718-852-9874

Provider Business Practice Location Address
First Line	:	267 SMITH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11231-4739
Country	:	US
Telephone Number	:	718-554-6230
Fax Number	:

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	07/08/2007

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