Healthcare Provider Details

I. General information

NPI: 1174037758
Provider Name (Legal Business Name): OCULUS MEDICAL EYE CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2017
Last Update Date: 08/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CENTRE ST STE 618
NEW YORK NY
10013
US

IV. Provider business mailing address

139 CENTRE ST STE 618
NEW YORK NY
10013-4556
US

V. Phone/Fax

Practice location:
  • Phone: 646-559-8808
  • Fax: 646-559-9950
Mailing address:
  • Phone: 646-559-8808
  • Fax: 646-559-9950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number260867
License Number StateNY

VIII. Authorized Official

Name: ANDREA JUE
Title or Position: PRESIDENT
Credential: MD
Phone: 646-559-8808