Healthcare Provider Details

I. General information

NPI: 1154589166
Provider Name (Legal Business Name): ECHO OPHTHALMIC DISPENSING, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 ECHO AVE
SOUND BEACH NY
11789-2324
US

IV. Provider business mailing address

243 ECHO AVE
SOUND BEACH NY
11789-2324
US

V. Phone/Fax

Practice location:
  • Phone: 631-821-8693
  • Fax: 631-821-7761
Mailing address:
  • Phone: 631-821-8693
  • Fax: 631-821-7761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number7538
License Number StateNY

VIII. Authorized Official

Name: CARMEL O'HANLON
Title or Position: OWNER/OPTICIAN
Credential:
Phone: 631-821-8693