Healthcare Provider Details

I. General information

NPI: 1386120616
Provider Name (Legal Business Name): PARKSLOPE EYE CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 10/09/2020
Certification Date: 10/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 9TH ST
BROOKLYN NY
11215-8129
US

IV. Provider business mailing address

PO BOX 150617
BROOKLYN NY
11215-0617
US

V. Phone/Fax

Practice location:
  • Phone: 718-869-4326
  • Fax:
Mailing address:
  • Phone: 718-869-4326
  • Fax:

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 State

VIII. Authorized Official

Name: RALPH MURRAY
Title or Position: PHYSICIAN
Credential: OD
Phone: 718-869-4326