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General NPI Number Information
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NPI Number | 1003022096
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Entity Type | Organization
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Legal Business Name | COOL IMAGE OPTICAL CORP
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/01/2008
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Provider Practice Location Address
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Address Line | 167 W 72ND ST
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City | NEW YORK
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State | NY
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Zip | 10023-3221
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Country | US
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Telephone | 212-769-1410
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Fax |
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Provider Business Mailing Address
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Address Line | 167 W 72ND ST
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City | NEW YORK
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State | NY
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Zip | 10023-3221
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Country | US
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Telephone | 212-769-1410
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELAINA ZAVILENSKY
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Credential |
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Telephone | 21277691410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 007121
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License Number State | NY
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