MEDICARE: DR. FARRAH JEAN-BAPTISTE 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	007096	NY

General Provider Information

NPI Number	:	1972671121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FARRAH JEAN-BAPTISTE OD

Provider Business Mailing Address
First Line	:	3133 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3133 E MAIN ST
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1521
Country	:	US
Telephone Number	:	914-526-1110
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	12/07/2012

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