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General NPI Number Information
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NPI Number | 1205097037
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Entity Type | Organization
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Legal Business Name | MORIAH EYECARE INC
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 3416 JEROME AVE
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City | BRONX
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State | NY
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Zip | 10467-1002
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Country | US
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Telephone | 718-325-3160
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Fax | 718-325-0226
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Provider Business Mailing Address
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Address Line | 3416 JEROME AVE
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City | BRONX
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State | NY
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Zip | 10467-1002
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Country | US
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Telephone | 718-325-3160
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Fax | 718-325-0226
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Authorized Official
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Title or Position | OWNER
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Name | MARY BUSTOS
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Credential |
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Telephone | 718-325-3160
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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 | TUV006204-1
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License Number State | NY
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