Healthcare Provider Details

I. General information

NPI: 1093795460
Provider Name (Legal Business Name): CHESTER S FICHANDLER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 FRANKLIN AVE
GARDEN CITY NY
11530-4524
US

IV. Provider business mailing address

PO BOX 2079
MASSAPEQUA NY
11758-0002
US

V. Phone/Fax

Practice location:
  • Phone: 516-746-2360
  • Fax: 516-294-1937
Mailing address:
  • Phone: 516-798-8903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV003179-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: