Healthcare Provider Details

I. General information

NPI: 1912775289
Provider Name (Legal Business Name): MING YAO ABOC, NCLEC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

667 FRANKLIN AVE
GARDEN CITY NY
11530-5778
US

IV. Provider business mailing address

667 FRANKLIN AVE
GARDEN CITY NY
11530-5778
US

V. Phone/Fax

Practice location:
  • Phone: 516-741-3706
  • Fax: 516-739-2390
Mailing address:
  • Phone: 516-741-3706
  • Fax: 516-739-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License NumberC008718
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC008718
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: