MEDICARE: MICHELLE & OLIVIA ENTERPRISE

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	332H00000X	Eyewear Supplier		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	:	1972759827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHELLE & OLIVIA ENTERPRISE

Provider Business Mailing Address
First Line	:	4101 KISSENA BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-3138
Country	:	US
Telephone Number	:	718-321-1212
Fax Number	:	718-321-3276

Provider Business Practice Location Address
First Line	:	4101 KISSENA BLVD
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355-3138
Country	:	US
Telephone Number	:	718-321-1212
Fax Number	:	718-321-3276

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DANIEL K KUNG
Credential	:
Telephone Number	:	718-321-1212

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	07/21/2022

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Directions to “MICHELLE & OLIVIA ENTERPRISE ” Practice Location

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