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General NPI Number Information
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NPI Number | 1114515467
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Entity Type | Organization
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Legal Business Name | LEGACY OPTICAL INC
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Dates
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Enumeration Date | 01/04/2021
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Last Update Date | 01/09/2021
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Provider Practice Location Address
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Address Line | 4 SPRINGVILLE RD STE A
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-2290
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Country | US
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Telephone | 631-875-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 4 SPRINGVILLE RD STE A
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City | HAMPTON BAYS
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State | NY
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Zip | 11946-2290
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Country | US
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Telephone | 631-875-4544
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/NYS OPHTHALMIC DISPENSER
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Name | MRS. LISA R PFLEGER
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Credential | ABOC
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Telephone | 631-728-3132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1202X
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Taxonomy Name | Optometric Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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