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General NPI Number Information
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NPI Number | 1346638434
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Entity Type | Organization
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Legal Business Name | ISLAND EYE OPTICAL CORP.
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Dates
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Enumeration Date | 12/26/2014
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Last Update Date | 12/26/2014
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Provider Practice Location Address
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Address Line | 1500 VICTORY BOULEVARD
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City | STATEN ISLAND
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State | NY
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Zip | 10301
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Country | US
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Telephone | 718-984-7616
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Fax | 718-984-8584
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Provider Business Mailing Address
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Address Line | 4299 HYLAN BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10312-6527
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Country | US
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Telephone | 718-984-7616
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Fax | 718-984-8584
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL NEJAT
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Credential | MD
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Telephone | 718-984-7616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 004733-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV0017979-1
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License Number State | NY
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