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General NPI Number Information
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NPI Number | 1336321728
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Entity Type | Organization
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Legal Business Name | CORONA OPTOMETRY, PC
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Dates
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Enumeration Date | 11/28/2007
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Last Update Date | 06/19/2012
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Provider Practice Location Address
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Address Line | 103-06 ROOSEVELT AVENUE
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City | CORONA
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State | NY
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Zip | 11368
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Country | US
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Telephone | 718-424-1333
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Fax | 718-424-1330
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Provider Business Mailing Address
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Address Line | 103-06 ROOSEVELT AVENUE
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City | CORONA
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State | NY
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Zip | 11368
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Country | US
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Telephone | 718-424-1333
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Fax | 718-424-1330
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PEZHMAN HOURIZADEH
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Credential | O.D.
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Telephone | 718-242-1333
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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 | TUV007045
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License Number State | NY
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