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General NPI Number Information
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NPI Number | 1356461859
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Entity Type | Organization
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Legal Business Name | L&K OPTICAL, INC.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 124 SMITH HAVEN MALL
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City | LAKE GROVE
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State | NY
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Zip | 11755-1214
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Country | US
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Telephone | 631-724-9055
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Fax | 631-724-9142
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Provider Business Mailing Address
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Address Line | 124 SMITH HAVEN MALL
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City | LAKE GROVE
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State | NY
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Zip | 11755-1214
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Country | US
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Telephone | 631-724-9055
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Fax | 631-724-9142
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Authorized Official
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Title or Position | OWNER
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Name | MR. SHLOMO LEIDERMAN
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Credential |
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Telephone | 631-724-9055
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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 | NY TUV003919-1
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License Number State | NY
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