Healthcare Provider Details

I. General information

NPI: 1114954344
Provider Name (Legal Business Name): EDWARD TODD KENT OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 WEST 14 TH STREET ECONOMY BEST VISION
NEW YORK NY
10011-7113
US

IV. Provider business mailing address

223 WEST 14TH STREET
NEW YORK NY
10011-7113
US

V. Phone/Fax

Practice location:
  • Phone: 212-243-4884
  • Fax:
Mailing address:
  • Phone: 212-243-4884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC004553-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: