Healthcare Provider Details

I. General information

NPI: 1164599734
Provider Name (Legal Business Name): LOW TOR OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 03/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 RAMAPO RD
GARNERVILLE NY
10923-1552
US

IV. Provider business mailing address

171 RAMAPO RD
GARNERVILLE NY
10923-1552
US

V. Phone/Fax

Practice location:
  • Phone: 845-947-2240
  • Fax:
Mailing address:
  • Phone: 845-947-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4314
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT CHEN
Title or Position: AUTHORIZED OFFICIAL
Credential: M.D
Phone: 845-947-2240