Healthcare Provider Details

I. General information

NPI: 1376465054
Provider Name (Legal Business Name): PARK SLOPE OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 7TH AVE
BROOKLYN NY
11215-7250
US

IV. Provider business mailing address

298 7TH AVE
BROOKLYN NY
11215-7250
US

V. Phone/Fax

Practice location:
  • Phone: 718-768-3939
  • Fax: 718-768-3933
Mailing address:
  • Phone: 718-768-3939
  • Fax: 718-768-3933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS D'EGIDIO
Title or Position: PRESIDENT
Credential:
Phone: 917-533-7320