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General NPI Number Information
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NPI Number | 1275889438
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Entity Type | Organization
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Legal Business Name | BAYSIDE FASHION OPTICAL
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 58-47 FRANCIS LEWIS BLVD. SUITE 202
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-1698
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Country | US
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Telephone | 718-224-5500
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Fax | 718-281-4634
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Provider Business Mailing Address
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Address Line | 58-47 FRANCIS LEWIS BLVD. SUITE 202
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City | OAKLAND GARDENS
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State | NY
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Zip | 11364-1698
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Country | US
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Telephone | 718-224-5500
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Fax | 718-281-4634
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Authorized Official
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Title or Position | OWNER
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Name | BARRY L. DRUCKER
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Credential | D.O.
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Telephone | 718-224-5500
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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 | 113906
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License Number State | NY
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