| |
1652 Richmond Ave Ste 4b, Staten Island, NY 10314-1576 | |
(718) 982-9602 | |
(718) 982-9607 |
Full Name | |
---|---|
Type | Facility |
Speciality | Non-pharmacy Dispensing Site |
Location | 1652 Richmond Ave Ste 4b, Staten Island, New York |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1538690938 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332900000X | Non-pharmacy Dispensing Site | (* (Not Available)) | Primary |
Provider Name | Sheldon S Retkinski |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1144301425 PECOS PAC ID: 1254506082 Enrollment ID: I20111207000017 |
Mailing Address | Practice Location Address |
---|---|
1652 Richmond Ave Ste 4b, Staten Island, NY 10314-1576 Ph: (718) 982-9607 | 1652 Richmond Ave Ste 4b, Staten Island, NY 10314-1576 Ph: (718) 982-9602 |