Healthcare Provider Details

I. General information

NPI: 1700159324
Provider Name (Legal Business Name): HEUER OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E 34TH ST
NEW YORK NY
10016-4601
US

IV. Provider business mailing address

101 E 34TH ST
NEW YORK NY
10016-4601
US

V. Phone/Fax

Practice location:
  • Phone: 212-679-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number0085391
License Number StateNY

VIII. Authorized Official

Name: MARK HUANG
Title or Position: MGMT
Credential: OD
Phone: 212-679-2020