Healthcare Provider Details

I. General information

NPI: 1891874244
Provider Name (Legal Business Name): ENRIQUE R. DELOS REYES OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 BELMONT AVE
LONG BEACH NY
11561-3807
US

IV. Provider business mailing address

124 BELMONT AVE
LONG BEACH NY
11561-3807
US

V. Phone/Fax

Practice location:
  • Phone: 516-889-7515
  • Fax: 516-889-7515
Mailing address:
  • Phone: 516-889-7515
  • Fax: 516-889-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number04389-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: