Healthcare Provider Details

I. General information

NPI: 1740359579
Provider Name (Legal Business Name): JEWEL OPTICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 51 PARSONS BLVD
FLUSHING NY
11365
US

IV. Provider business mailing address

70 51 PARSONS BLVD
FLUSHING NY
11365
US

V. Phone/Fax

Practice location:
  • Phone: 718-380-7788
  • Fax: 718-380-7788
Mailing address:
  • Phone: 718-380-7788
  • Fax: 718-380-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004333-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number008847-1
License Number StateNY

VIII. Authorized Official

Name: DAVID PAZOS
Title or Position: OPTICIAN
Credential:
Phone: 718-380-7788