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General NPI Number Information
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NPI Number | 1023445046
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Entity Type | Organization
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Legal Business Name | SOLANO OPTICAL BOUTIQUE LTD
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Dates
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Enumeration Date | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 1321 FULTON ST
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City | BROOKLYN
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State | NY
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Zip | 11216-2292
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Country | US
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Telephone | 718-623-1220
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Fax | 718-623-1220
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Provider Business Mailing Address
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Address Line | 1321 FULTON ST
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City | BROOKLYN
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State | NY
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Zip | 11216-2292
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Country | US
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Telephone | 718-623-1220
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Fax | 718-623-1220
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Authorized Official
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Title or Position | OWNER
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Name | MR. JUAN E SOLANO
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Credential |
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Telephone | 718-623-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 04857
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License Number State | NY
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