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General NPI Number Information
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NPI Number | 1326160854
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Entity Type | Organization
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Legal Business Name | MERMAID OPTICAL
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/03/2007
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Provider Practice Location Address
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Address Line | 2819 MERMAID AVE
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City | BROOKLYN
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State | NY
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Zip | 11224-2068
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Country | US
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Telephone | 718-265-6066
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Fax | 718-265-0665
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Provider Business Mailing Address
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Address Line | 2819 MERMAID AVE
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City | BROOKLYN
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State | NY
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Zip | 11224-2068
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Country | US
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Telephone | 718-265-6066
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Fax | 718-265-0665
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. PAVEL SHINDER
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Credential |
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Telephone | 718-265-6066
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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 | 005465
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License Number State | NY
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