Healthcare Provider Details

I. General information

NPI: 1326193509
Provider Name (Legal Business Name): SK OPTICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 BAY ST SUITE F
STATEN ISLAND NY
10305-4937
US

IV. Provider business mailing address

1140 BAY ST SUITE F
STATEN ISLAND NY
10305-4937
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-7483
  • Fax: 718-815-8063
Mailing address:
  • Phone: 718-447-7483
  • Fax: 718-815-8063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT006107
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC3191
License Number StateNY

VIII. Authorized Official

Name: MR. STANLEY I SOLOMON
Title or Position: OWNER
Credential: OPTICIAN
Phone: 718-447-7483