Healthcare Provider Details

I. General information

NPI: 1124194808
Provider Name (Legal Business Name): BRONX EYE CARE OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 SOUTHERN BLVD
BRONX NY
10459-3407
US

IV. Provider business mailing address

2075 BARTOW AVE
BRONX NY
10475-4613
US

V. Phone/Fax

Practice location:
  • Phone: 718-328-7137
  • Fax: 718-378-0160
Mailing address:
  • Phone: 718-320-0049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: PEARLINA NELMS
Title or Position: OFFICE MANAGER
Credential:
Phone: 718-320-0049