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General NPI Number Information
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NPI Number | 1275587610
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Entity Type | Organization
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Legal Business Name | WOODHAVEN OPTICAL CENTER
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Dates
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Enumeration Date | 05/20/2006
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Last Update Date | 05/11/2011
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Provider Practice Location Address
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Address Line | 8921 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2041
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Country | US
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Telephone | 718-847-1946
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Fax | 718-849-7326
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Provider Business Mailing Address
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Address Line | 8921 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2041
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Country | US
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Telephone | 718-847-1946
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Fax | 718-849-7326
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JEFFREY M LEITER
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Credential | O.D.
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Telephone | 718-847-1946
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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 | 004302
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License Number State | NY
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