Jet Thanetr Ruttanasee, OD | |
7010 Austin St Ste 2, Forest Hills, NY 11375-4763 | |
(718) 575-8288 | |
Not Available |
Full Name | Jet Thanetr Ruttanasee |
---|---|
Gender | Male |
Speciality | Optometrist |
Location | 7010 Austin St Ste 2, Forest Hills, New York |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1396931689 | NPI | - | NPPES |
03086528 | Medicaid | NY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | TUV 007165 (New York) | Primary |
Provider Name | Mk Vision Center Llc |
---|---|
Provider Type | Part B Supplier - Clinic/group Practice |
Provider Identifiers | NPI Number: 1396158531 PECOS PAC ID: 5496931248 Enrollment ID: O20140807000838 |
Mailing Address | Practice Location Address |
---|---|
Jet Thanetr Ruttanasee, OD 11035 72nd Rd, Apt. 605, Forest Hills, NY 11375-5471 Ph: (347) 901-0183 | Jet Thanetr Ruttanasee, OD 7010 Austin St Ste 2, Forest Hills, NY 11375-4763 Ph: (718) 575-8288 |
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