Healthcare Provider Details

I. General information

NPI: 1063576106
Provider Name (Legal Business Name): ROBERT H. DUCKMAN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WEST 42ND STREET UNIVERSITY OPTOMETRIC CENTER
NEW YORK NY
10036-8003
US

IV. Provider business mailing address

33 WEST 42ND STREET UNIVERSITY OPTOMETRIC CENTER
NEW YORK NY
10036-8003
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-5857
  • Fax: 212-938-5670
Mailing address:
  • Phone: 212-938-5857
  • Fax: 212-938-5670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number002886
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: