MEDICARE: A & S OPTICAL BOUTIQUE

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

General Provider Information

NPI Number	:	1982885232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A & S OPTICAL BOUTIQUE

Provider Business Mailing Address
First Line	:	1308 78TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-2720
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4901 9TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2423
Country	:	US
Telephone Number	:	718-283-8639
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEX RITS
Credential	:
Telephone Number	:	718-283-7999

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	01/14/2010

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Directions to “A & S OPTICAL BOUTIQUE ” Practice Location

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