Healthcare Provider Details

I. General information

NPI: 1477598555
Provider Name (Legal Business Name): ROCKLEDGE OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S CENTRAL AVE
ELMSFORD NY
10523-3509
US

IV. Provider business mailing address

160 S CENTRAL AVE
ELMSFORD NY
10523-3509
US

V. Phone/Fax

Practice location:
  • Phone: 914-347-2266
  • Fax:
Mailing address:
  • Phone: 914-347-2266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JOHN GIAMBALVO
Title or Position: OPTICAN
Credential:
Phone: 914-347-2266