Healthcare Provider Details

I. General information

NPI: 1154465623
Provider Name (Legal Business Name): RYCAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 ATLANTIC AVE
OCEANSIDE NY
11572-2037
US

IV. Provider business mailing address

40 ATLANTIC AVE
OCEANSIDE NY
11572-2037
US

V. Phone/Fax

Practice location:
  • Phone: 516-255-2020
  • Fax: 516-255-1818
Mailing address:
  • Phone: 516-255-2020
  • Fax: 516-255-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number005759
License Number StateNY

VIII. Authorized Official

Name: MR. RICHARD TRAFICANTE
Title or Position: OWNER
Credential:
Phone: 516-255-2020