Healthcare Provider Details

I. General information

NPI: 1679031413
Provider Name (Legal Business Name): WEST SIDE EYE SPECS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2165 BROADWAY
NEW YORK NY
10024-6603
US

IV. Provider business mailing address

2165 BROADWAY
NEW YORK NY
10024-6603
US

V. Phone/Fax

Practice location:
  • Phone: 212-877-2980
  • Fax: 212-877-0549
Mailing address:
  • Phone: 212-877-2980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAVID HYDE
Title or Position: OPTOMETRIST
Credential: OD
Phone: 212-877-2980