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General NPI Number Information
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NPI Number | 1124487616
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Entity Type | Organization
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Legal Business Name | BODIM OPTICAL INC
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Dates
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Enumeration Date | 02/12/2016
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Last Update Date | 02/12/2016
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Provider Practice Location Address
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Address Line | 1445 HEMPSTEAD TPKE
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City | ELMONT
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State | NY
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Zip | 11003-2400
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Country | US
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Telephone | 516-616-1771
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Fax |
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Provider Business Mailing Address
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Address Line | 1445 HEMPSTEAD TPKE
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City | ELMONT
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State | NY
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Zip | 11003-2400
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Country | US
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Telephone | 516-616-1771
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Fax |
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Authorized Official
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Title or Position | OPHTHALMIC DISPENSER
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Name | MR. BOAZ BEN-JACOB
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Credential | DO
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Telephone | 516-616-1771
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 007987
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License Number State | NY
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