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General NPI Number Information
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NPI Number | 1356460968
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Entity Type | Organization
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Legal Business Name | OPTOMETRIC EYE SERVICES LLC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 03/16/2018
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Provider Practice Location Address
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Address Line | 10 SHERIDAN SQ
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City | NEW YORK
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State | NY
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Zip | 10014-6867
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Country | US
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Telephone | 212-242-6592
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Fax |
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Provider Business Mailing Address
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Address Line | 637 WYCKOFF AVE. STE 233
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City | WYCKOFF
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State | NJ
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Zip | 07481
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Country | US
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Telephone | 201-694-7701
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. VICTORIA L. ZUPA
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Credential | OD
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Telephone | 201-694-7701
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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 | NY5512
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License Number State | NY
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