Healthcare Provider Details

I. General information

NPI: 1427007053
Provider Name (Legal Business Name): WITZ OPTICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 RICHMOND AVE
STATEN ISLAND NY
10314-3918
US

IV. Provider business mailing address

2303 RICHMOND AVE
STATEN ISLAND NY
10314-3918
US

V. Phone/Fax

Practice location:
  • Phone: 718-982-9602
  • Fax: 718-982-9607
Mailing address:
  • Phone: 718-982-9602
  • Fax: 718-982-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTU003858
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number004641
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number006692
License Number StateNY

VIII. Authorized Official

Name: DR. NEIL COOPER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 718-982-9602