Healthcare Provider Details

I. General information

NPI: 1114061330
Provider Name (Legal Business Name): JOSEPH LERNER OPTICIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WASHINGTON AVE SUITE 2
PLAINVIEW NY
11803-4045
US

IV. Provider business mailing address

10 WASHINGTON AVE SUITE 2
PLAINVIEW NY
11803-4045
US

V. Phone/Fax

Practice location:
  • Phone: 516-931-0110
  • Fax: 516-470-0025
Mailing address:
  • Phone: 516-931-0110
  • Fax: 516-470-0025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number5062
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: