Healthcare Provider Details

I. General information

NPI: 1851663918
Provider Name (Legal Business Name): OPTICAL ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2012
Last Update Date: 02/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W 45TH ST SUITE 504
NEW YORK NY
10036-4005
US

IV. Provider business mailing address

115 W 45TH ST SUITE 504
NEW YORK NY
10036-4005
US

V. Phone/Fax

Practice location:
  • Phone: 180-061-0823
  • Fax:
Mailing address:
  • Phone: 180-061-0823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006888-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number009212-1
License Number StateNY

VIII. Authorized Official

Name: ABEER AYOUB
Title or Position: OPTICIAN
Credential:
Phone: 718-607-1068