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General NPI Number Information
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NPI Number | 1225164072
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE OPHTHALMOLOGY,P.C.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 1175 W BROADWAY SUITE 25
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City | HEWLETT
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State | NY
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Zip | 11557-1922
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Country | US
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Telephone | 516-374-1122
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Fax | 516-374-1025
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Provider Business Mailing Address
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Address Line | 1175 W BROADWAY SUITE 25
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City | HEWLETT
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State | NY
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Zip | 11557-1922
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Country | US
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Telephone | 516-374-1122
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Fax | 516-374-1025
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM HARRY BOOCKVAR
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Credential | MD
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Telephone | 516-374-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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