Healthcare Provider Details

I. General information

NPI: 1497896872
Provider Name (Legal Business Name): THE VILLAGE OPTICIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MAIN ST
NEW ROCHELLE NY
10801-6334
US

IV. Provider business mailing address

521 MAIN ST
NEW ROCHELLE NY
10801-6334
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-5151
  • Fax:
Mailing address:
  • Phone: 914-245-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND KOLKMANN
Title or Position: OWNER
Credential:
Phone: 914-245-5151