Healthcare Provider Details

I. General information

NPI: 1093001414
Provider Name (Legal Business Name): EMERGENCY OPTHAMOLOGY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 06/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PARK AVE
NEW YORK NY
10065-7369
US

IV. Provider business mailing address

550 PARK AVE
NEW YORK NY
10065-7369
US

V. Phone/Fax

Practice location:
  • Phone: 714-289-1559
  • Fax: 714-289-0280
Mailing address:
  • Phone: 212-832-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number174683-1
License Number StateNY

VIII. Authorized Official

Name: MARK FROMER
Title or Position: PRESIDENT
Credential: MD
Phone: 714-289-1559