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General NPI Number Information
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NPI Number | 1124278270
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Entity Type | Organization
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Legal Business Name | OPTIMUM VISION, CORP
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 210 BROADWAY MALL
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City | HICKSVILLE
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State | NY
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Zip | 11801-2709
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Country | US
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Telephone | 516-938-0055
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Fax | 516-938-8667
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Provider Business Mailing Address
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Address Line | 210 BROADWAY MALL
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City | HICKSVILLE
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State | NY
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Zip | 11801-2709
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Country | US
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Telephone | 516-938-0055
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Fax | 516-938-8667
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Authorized Official
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Title or Position | OFFICE ASSISTANT
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Name | MICHELLE ERICKSEN
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Credential |
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Telephone | 718-477-6700
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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 | TUV005761-1
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License Number State | NY
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