Healthcare Provider Details

I. General information

NPI: 1720156904
Provider Name (Legal Business Name): OPYICA 207 INTERNATIONAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

573 WEST 207 STREET
NEW YORK NY
10034-2607
US

IV. Provider business mailing address

573 WEST 207 STREET
NEW YORK NY
10034-2607
US

V. Phone/Fax

Practice location:
  • Phone: 212-569-3099
  • Fax: 212-569-3166
Mailing address:
  • Phone: 212-569-3099
  • Fax: 212-569-3166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number0073791
License Number StateNY

VIII. Authorized Official

Name: GUILLERMO YSMAEL REYES
Title or Position: PRESIDENT
Credential:
Phone: 212-569-3099