Healthcare Provider Details

I. General information

NPI: 1588742605
Provider Name (Legal Business Name): BEECHHURST EYE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 149TH ST
WHITESTONE NY
11357-2519
US

IV. Provider business mailing address

1430 149TH ST
WHITESTONE NY
11357-2519
US

V. Phone/Fax

Practice location:
  • Phone: 718-767-5444
  • Fax: 718-767-5444
Mailing address:
  • Phone: 718-767-5444
  • Fax: 718-767-5444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MS. MINDY C GOODMAN
Title or Position: OWNER/PRES.
Credential:
Phone: 718-767-5444