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General NPI Number Information
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NPI Number | 1346300548
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Entity Type | Organization
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Legal Business Name | BRENTWOOD VISION CENTER INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 601 SUFFOLK AVENUE SUITE 1
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City | BRENTWOOD
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State | NY
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Zip | 11717-4309
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Country | US
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Telephone | 631-273-3335
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Fax | 631-273-0310
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Provider Business Mailing Address
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Address Line | 601 SUFFOLK AVENUE SUITE 1
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City | BRENTWOOD
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State | NY
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Zip | 11717-4309
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Country | US
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Telephone | 631-273-3335
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Fax | 631-273-0310
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRANK S LOFORTE
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Credential |
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Telephone | 631-273-3335
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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 | NY67930
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License Number State | NY
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