Healthcare Provider Details

I. General information

NPI: 1548249022
Provider Name (Legal Business Name): ROGOT OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 03/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DYCKMAN ST
NEW YORK NY
10040-1001
US

IV. Provider business mailing address

110 DYCKMAN ST
NEW YORK NY
10040-1001
US

V. Phone/Fax

Practice location:
  • Phone: 212-567-6789
  • Fax: 212-304-1184
Mailing address:
  • Phone: 212-567-6789
  • Fax: 212-304-1184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID ROGOT
Title or Position: PRESIDENT
Credential:
Phone: 212-567-6789