Healthcare Provider Details

I. General information

NPI: 1407852684
Provider Name (Legal Business Name): HARVEY I ESTREN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

164 N WELLWOOD AVE
LINDENHURST NY
11757-4006
US

IV. Provider business mailing address

PO BOX 520
LINDENHURST NY
11757-0520
US

V. Phone/Fax

Practice location:
  • Phone: 631-226-2313
  • Fax: 631-226-3169
Mailing address:
  • Phone: 631-226-2313
  • Fax: 631-226-3169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberVUT 3256-1 NY
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberVUT 3256-1 NY
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberVUT 3256-1 NY
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberVUT-3256-1 NY
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: