Healthcare Provider Details

I. General information

NPI: 1679813422
Provider Name (Legal Business Name): JING J CAI OD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7305 168TH ST
FRESH MEADOWS NY
11366-1330
US

IV. Provider business mailing address

7305 168TH ST
FRESH MEADOWS NY
11366-1330
US

V. Phone/Fax

Practice location:
  • Phone: 347-878-9598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007406
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberTUV007406
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTUV007406
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberTUV007406
License Number StateNY

VIII. Authorized Official

Name: DR. JING J CAI
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 917-627-8397