Healthcare Provider Details

I. General information

NPI: 1275452658
Provider Name (Legal Business Name): AUNGAUNG OO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 PELHAM PKWY N
BRONX NY
10467-8068
US

IV. Provider business mailing address

6156 220TH ST
BAYSIDE NY
11364-2245
US

V. Phone/Fax

Practice location:
  • Phone: 718-208-4739
  • Fax:
Mailing address:
  • Phone: 917-877-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number011425
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: