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General NPI Number Information
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NPI Number | 1245547694
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Entity Type | Organization
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Legal Business Name | NORTH QUEENS OPTOMETRIC ASSOCIATES PLLC
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Dates
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Enumeration Date | 09/07/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 13505 20TH AVE
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City | COLLEGE POINT
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State | NY
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Zip | 11356-2446
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Country | US
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Telephone | 718-661-0713
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Fax |
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Provider Business Mailing Address
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Address Line | 919 N BAY AVE
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City | MASSAPEQUA
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State | NY
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Zip | 11758-2545
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Country | US
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Telephone | 516-541-7861
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | LISA CHAN-O'CONNELL
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Credential | O.D.
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Telephone | 516-426-5526
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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 | TUV 006091
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License Number State | NY
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