Healthcare Provider Details

I. General information

NPI: 1639826076
Provider Name (Legal Business Name): BOSS VISION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 03/06/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MOTT ST
NEW YORK NY
10013-4629
US

IV. Provider business mailing address

111 MOTT ST
NEW YORK NY
10013-4629
US

V. Phone/Fax

Practice location:
  • Phone: 646-590-3177
  • Fax:
Mailing address:
  • Phone: 646-590-3177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUNJIE CHEN
Title or Position: MANAGER
Credential:
Phone: 646-590-3177