MEDICARE: SERGIO MARANO O.D. MARK GRISAR O.D. PC

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

General Provider Information

NPI Number	:	1992783864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERGIO MARANO O.D. MARK GRISAR O.D. PC

Provider Business Mailing Address
First Line	:	1765 CENTRAL PARK AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710-2828
Country	:	US
Telephone Number	:	914-961-1004
Fax Number	:	914-961-7636

Provider Business Practice Location Address
First Line	:	1765 CENTRAL PARK AVE
Second Line	:
City	:	YONKERS
State	:	NY
Zip	:	10710-2828
Country	:	US
Telephone Number	:	914-961-1004
Fax Number	:	914-961-7636

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SERGIO MARANO
Credential	:	O.D.
Telephone Number	:	914-961-1004

Provider Enumeration Date	:	01/02/2006
Last Update Date	:	10/11/2013

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