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General NPI Number Information
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NPI Number | 1154024768
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Entity Type | Organization
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Legal Business Name | SWDJ LLC
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Dates
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Enumeration Date | 03/23/2023
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 15 DIVISION ST
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City | NEW YORK
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State | NY
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Zip | 10002-6710
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Country | US
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Telephone | 646-476-5210
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Fax | 646-476-5207
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Provider Business Mailing Address
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Address Line | 15 DIVISION ST
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City | NEW YORK
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State | NY
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Zip | 10002-6710
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Country | US
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Telephone | 646-476-5210
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Fax | 646-476-5207
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/OWNER
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Name | DAWEI SUN
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Credential |
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Telephone | 646-476-5210
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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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Taxonomy #2
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number |
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License Number State |
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