Healthcare Provider Details

I. General information

NPI: 1477957322
Provider Name (Legal Business Name): METRO OPTICS THROGS NECK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 10/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HUTCHINSON RIVER PKWY SUITE 797
BRONX NY
10465-1818
US

IV. Provider business mailing address

815 HUTCHINSON RIVER PKWY SUITE 797
BRONX NY
10465-1818
US

V. Phone/Fax

Practice location:
  • Phone: 718-569-5680
  • Fax:
Mailing address:
  • Phone: 718-569-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004217
License Number StateNY

VIII. Authorized Official

Name: DR. EVA YAN
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 718-597-6162