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General NPI Number Information
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NPI Number | 1154667764
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Entity Type | Organization
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Legal Business Name | JEWELERS & OPTICALS LTD
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 6626 METROPOLITAN AVE
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1630
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Country | US
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Telephone | 718-366-8193
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Fax |
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Provider Business Mailing Address
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Address Line | 6626 METROPOLITAN AVE
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City | MIDDLE VILLAGE
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State | NY
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Zip | 11379-1630
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Country | US
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Telephone | 718-366-8193
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SOLOMON MATATOV
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Credential |
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Telephone | 718-366-8193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 1449548
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License Number State | NY
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