Organization
SPECIALIZED EYE CARE OF BAY RIDGE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOANNE L PASS (ADMINISTRATOR)
(917) 848-5484
Entity
Organization
Contact information
Practice address
8723 3RD AVE, BROOKLYN, NY 11209-5103
(718) 491-2020
Mailing address
8723 3RD AVE, BROOKLYN, NY 11209-5103
(718) 491-2020
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
009057
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7183350001
MEDICARE PTAN
NY
Enumeration date
06/02/2014
Last updated
10/08/2014
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