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General NPI Number Information
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NPI Number | 1184996001
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Entity Type | Organization
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Legal Business Name | COSMOS TOTAL OPTOMETRY CARE PLLC
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 9001 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7938
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Country | US
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Telephone | 718-458-8500
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Fax | 718-424-3366
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Provider Business Mailing Address
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Address Line | 9001 ROOSEVELT AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7938
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Country | US
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Telephone | 718-458-8500
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Fax | 718-424-3366
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. JOANNE ECONOPOULY
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Credential | O.D.
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Telephone | 718-458-8500
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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 | TUV006061
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License Number State | NY
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