Healthcare Provider Details

I. General information

NPI: 1003908278
Provider Name (Legal Business Name): CLEAR VIEW OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 BURKE AVE
BRONX NY
10467-6609
US

IV. Provider business mailing address

11155 77TH AVE APT. #1C
FOREST HILLS NY
11375-7035
US

V. Phone/Fax

Practice location:
  • Phone: 718-547-1600
  • Fax:
Mailing address:
  • Phone: 718-793-3096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT003850-1
License Number StateNY

VIII. Authorized Official

Name: DR. CHARLES SUMMER CHATMAN
Title or Position: CO-OWNER
Credential: O.D.
Phone: 718-547-1600