Healthcare Provider Details

I. General information

NPI: 1275637548
Provider Name (Legal Business Name): 25 WESTCHESTER SQUARE OPTICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 WESTCHESTER SQ
BRONX NY
10461-3545
US

IV. Provider business mailing address

25 WESTCHESTER SQ
BRONX NY
10461-3545
US

V. Phone/Fax

Practice location:
  • Phone: 718-597-6162
  • Fax: 718-597-6168
Mailing address:
  • Phone: 718-597-6162
  • Fax: 718-597-6168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

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