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General NPI Number Information
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NPI Number | 1174830988
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Entity Type | Organization
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Legal Business Name | SUNNYSIDE OPTOMETRY P.C.
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 4701 QUEENS BLVD SUITE NUMBER 303
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City | SUNNYSIDE
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State | NY
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Zip | 11104-1600
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Country | US
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Telephone | 516-801-6323
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Fax | 888-314-7302
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Provider Business Mailing Address
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Address Line | 7 SINCLAIR MARTIN DR
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City | ROSLYN
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State | NY
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Zip | 11576-1184
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Country | US
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Telephone | 516-801-6323
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Fax | 888-314-7302
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL VARUJAN KALUSTIAN
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Credential | O.D.
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Telephone | 516-801-6323
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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 | T006238
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | T006238
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | T006238
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T006238
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License Number State | NY
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