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General NPI Number Information
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NPI Number | 1023183381
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Entity Type | Organization
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Legal Business Name | R & I OPTICAL
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 02/25/2010
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Provider Practice Location Address
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Address Line | 5625 MYRTLE AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4740
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Country | US
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Telephone | 718-497-5470
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Fax | 718-386-0532
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Provider Business Mailing Address
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Address Line | 5625 MYRTLE AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4740
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Country | US
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Telephone | 718-497-5470
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Fax | 718-386-0532
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MIKHAIL RAYTSIN
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Credential |
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Telephone | 718-497-5470
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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 | 0919660001
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License Number State | NY
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