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General NPI Number Information
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NPI Number | 1194226886
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Entity Type | Organization
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Legal Business Name | ESAD OPTICAL, INC
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 6332 NORTHERN BLVD
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City | EAST NORWICH
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State | NY
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Zip | 11732-1600
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Country | US
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Telephone | 516-624-3149
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Fax |
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Provider Business Mailing Address
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Address Line | 708 SEABURY AVE
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City | FRANKLIN SQUARE
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State | NY
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Zip | 11010-4112
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Country | US
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Telephone | 516-641-1768
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELISA F DE JUNCO
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Credential | OD
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Telephone | 516-641-1768
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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 | TUV004987
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | TUV004987
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV004987
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License Number State | NY
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