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General NPI Number Information
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NPI Number | 1104581032
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Entity Type | Organization
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Legal Business Name | PARK AVENUE OPTOMETRY PLLC
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Dates
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Enumeration Date | 11/04/2021
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Last Update Date | 11/04/2021
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Provider Practice Location Address
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Address Line | 287 PARK AVE S STE 1A
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City | NEW YORK
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State | NY
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Zip | 10010-4573
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Country | US
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Telephone | 332-345-2363
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Fax | 332-345-2364
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Provider Business Mailing Address
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Address Line | 287 PARK AVE S STE 1A
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City | NEW YORK
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State | NY
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Zip | 10010-4573
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Country | US
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Telephone | 332-345-2363
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Fax | 332-345-2364
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Authorized Official
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Title or Position | OD/OWNER
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Name | DR. IRINA SHIYAN
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Credential | OD
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Telephone | 332-345-2363
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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 |
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License Number State |
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