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General NPI Number Information
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NPI Number | 1326172586
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Entity Type | Organization
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Legal Business Name | OPTICAL EYE PC
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3760 94TH ST
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7934
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Country | US
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Telephone | 718-205-1280
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Fax | 718-205-1223
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Provider Business Mailing Address
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Address Line | 45 KIRKWOOD DRIVE
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City | GLEN COVE
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State | NY
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Zip | 11542
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Country | US
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Telephone | 718-205-1280
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Fax | 718-205-1223
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. TONG LEE
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Credential | OD
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Telephone | 718-205-1280
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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 | 006735
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License Number State | NY
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