Healthcare Provider Details

I. General information

NPI: 1508783184
Provider Name (Legal Business Name): WOODSIDE EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 BROADWAY
WOODSIDE NY
11377-1730
US

IV. Provider business mailing address

5311 BROADWAY
WOODSIDE NY
11377-1730
US

V. Phone/Fax

Practice location:
  • Phone: 347-294-9853
  • Fax:
Mailing address:
  • Phone: 347-294-9853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARWAN KASSIM
Title or Position: PROVIDER
Credential: OD
Phone: 347-294-9853