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NPI Code Detail

MEDICARE: EYEWEAR PALACE INC.

MEDICARE: EYEWEAR PALACE 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
1152W00000XOptometrist

General Provider Information

NPI Number : 1962053009
Entity Type Code : Organization
Provider Name (Legal Business Name) : EYEWEAR PALACE INC.
Provider Business Mailing Address
First Line : 66 COURT ST STE B
Second Line :
City : BROOKLYN
State : NY
Zip : 11201-4905
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 66 COURT ST STE B
Second Line :
City : BROOKLYN
State : NY
Zip : 11201-4905
Country : US
Telephone Number : 718-625-7500
Fax Number :
Authorized Official
Title or Position : AO
Name : DR. ELENA FELDMAN
Credential : OD
Telephone Number : 646-734-6367
Provider Enumeration Date : 09/20/2019
Last Update Date : 09/20/2019

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