MEDICARE: INTERMED OPTICAL, INC

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	0084861	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	:	1952479982
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMED OPTICAL, INC

Provider Business Mailing Address
First Line	:	1849 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3108
Country	:	US
Telephone Number	:	718-621-1624
Fax Number	:

Provider Business Practice Location Address
First Line	:	1849 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-3108
Country	:	US
Telephone Number	:	718-621-1624
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LENNY TEMIRYAYEV
Credential	:	O.D.
Telephone Number	:	718-621-1624

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	08/22/2020

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Directions to “INTERMED OPTICAL, INC ” Practice Location

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