Healthcare Provider Details

I. General information

NPI: 1174039531
Provider Name (Legal Business Name): GRAHAM EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 GRAHAM AVE
BROOKLYN NY
11206-3334
US

IV. Provider business mailing address

102 GRAHAM AVE
BROOKLYN NY
11206-3334
US

V. Phone/Fax

Practice location:
  • Phone: 718-406-0478
  • Fax: 718-705-4221
Mailing address:
  • Phone: 718-406-0478
  • Fax: 718-705-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNY

VIII. Authorized Official

Name: DAVID H LEE
Title or Position: OPHTHALMOLOGIST
Credential: MD
Phone: 718-406-0478