Healthcare Provider Details

I. General information

NPI: 1679610273
Provider Name (Legal Business Name): EYES ON THE BEACH INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 05/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16055 CROSSBAY BLVD
HOWARD BEACH NY
11414-3431
US

IV. Provider business mailing address

16055 CROSSBAY BOULEVARD
HOWARD BEACH NY
11414
US

V. Phone/Fax

Practice location:
  • Phone: 171-883-5202
  • Fax: 718-835-2020
Mailing address:
  • Phone: 718-835-2020
  • Fax: 718-835-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNY

VIII. Authorized Official

Name: JEFFREY FRIEDMAN
Title or Position: OPTICIAN
Credential:
Phone: 718-835-2020