Healthcare Provider Details

I. General information

NPI: 1740359983
Provider Name (Legal Business Name): EYEWORLD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 W MERRICK RD
FREEPORT NY
11520-3712
US

IV. Provider business mailing address

185 W MERRICK RD
FREEPORT NY
11520-3712
US

V. Phone/Fax

Practice location:
  • Phone: 516-867-1213
  • Fax: 516-867-1214
Mailing address:
  • Phone: 516-867-1213
  • Fax: 516-867-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004726-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number4715
License Number StateNY

VIII. Authorized Official

Name: MR. PAUL L. HELLER
Title or Position: SECRETARY
Credential: OPTICIAN
Phone: 516-867-1213