Healthcare Provider Details

I. General information

NPI: 1891013546
Provider Name (Legal Business Name): HEUER OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 05/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 3RD AVE
NEW YORK NY
10016-6027
US

IV. Provider business mailing address

458 3RD AVE
NEW YORK NY
10016-6027
US

V. Phone/Fax

Practice location:
  • Phone: 212-696-5990
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27202010
License Number StateNY

VIII. Authorized Official

Name: MICHAEL THOMAS
Title or Position: MANAGER
Credential: O.D.
Phone: 212-696-5990