Healthcare Provider Details

I. General information

NPI: 1417053448
Provider Name (Legal Business Name): 14TH STREET OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 W 14TH ST
NEW YORK NY
10011-7517
US

IV. Provider business mailing address

2 W 14TH ST
NEW YORK NY
10011-7517
US

V. Phone/Fax

Practice location:
  • Phone: 212-989-3937
  • Fax: 212-462-4483
Mailing address:
  • Phone: 212-989-3937
  • Fax: 212-462-4483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNY

VIII. Authorized Official

Name: MRS. ELYSE GAIL ROTHSCHILD
Title or Position: PRESIDENT
Credential:
Phone: 212-989-3937