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General NPI Number Information
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NPI Number | 1053473512
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Entity Type | Organization
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Legal Business Name | CLEAR QUEST
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1401 ROUTE 300 NEWBURGH MALL
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City | NEWBURGH
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State | NY
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Zip | 12550-2990
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Country | US
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Telephone | 845-566-9179
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 ROUTE 300 NEWBURGH MALL
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City | NEWBURGH
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State | NY
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Zip | 12550-2990
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Country | US
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Telephone | 845-566-9179
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. RICHARD WEINTRAUB
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Credential | O. D.
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Telephone | 845-566-9179
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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 | 2766
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License Number State | NY
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