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General NPI Number Information
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NPI Number | 1235780719
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Entity Type | Organization
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Legal Business Name | COCOS VISION DESIGNER OPTICAL
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Dates
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Enumeration Date | 09/25/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 3185 STEINWAY ST
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City | ASTORIA
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State | NY
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Zip | 11103-3908
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Country | US
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Telephone | 718-685-2009
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Fax |
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Provider Business Mailing Address
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Address Line | 3185 STEINWAY ST
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City | ASTORIA
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State | NY
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Zip | 11103-3908
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Country | US
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Telephone | 718-685-2009
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ETHAN FARAONOV
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Credential |
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Telephone | 516-727-5070
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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 |
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License Number State |
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