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General NPI Number Information
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NPI Number | 1255581609
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Entity Type | Organization
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Legal Business Name | RIVERDALE VISION CARE, P.A.
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 02/25/2009
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Provider Practice Location Address
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Address Line | 92 ROUTE 23 NORTH SUITE E
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City | RIVERDALE
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State | NJ
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Zip | 07457
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Country | US
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Telephone | 917-623-7129
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Fax |
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Provider Business Mailing Address
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Address Line | 105 GREENE ST APT 1502
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City | JERSEY CITY
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State | NJ
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Zip | 07302-3848
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Country | US
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Telephone | 917-623-7129
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. SUDAPORN TANPATTANA
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Credential | O.D.
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Telephone | 917-623-7129
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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 | 27OA 00594603
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License Number State | NJ
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