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General NPI Number Information
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NPI Number | 1164649133
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Entity Type | Organization
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Legal Business Name | WINDSOR PARK VISION CENTER, LTD
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 21411 73RD AVE
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2947
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Country | US
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Telephone | 718-225-5533
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Fax | 718-225-5803
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Provider Business Mailing Address
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Address Line | 21411 73RD AVE
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-2947
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Country | US
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Telephone | 718-225-5533
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Fax | 718-225-5803
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. CARL ROTHMAN
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Credential | FNAO, ABO, NCLE
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Telephone | 718-225-5533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | C4579
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License Number State | NY
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