Healthcare Provider Details

I. General information

NPI: 1427133289
Provider Name (Legal Business Name): SPECIAL EYES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2791 RICHMOND AVE
STATEN ISLAND NY
10314-5859
US

IV. Provider business mailing address

2791 RICHMOND AVENUE
STATEN ISLAND NY
10314
US

V. Phone/Fax

Practice location:
  • Phone: 718-494-9257
  • Fax: 718-494-4183
Mailing address:
  • Phone: 718-494-9257
  • Fax: 718-494-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV0045731
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberC0038731
License Number StateNY

VIII. Authorized Official

Name: SALVATORE TARANTOLA
Title or Position: OPTICIAN
Credential:
Phone: 718-494-9257