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General NPI Number Information
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NPI Number | 1356677876
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Entity Type | Organization
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Legal Business Name | WOODSIDE OPTOMETRY PC
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Dates
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Enumeration Date | 10/19/2009
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Last Update Date | 10/19/2009
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Provider Practice Location Address
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Address Line | 4811 QUEENS BLVD
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City | FLUSHING
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State | NY
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Zip | 11377-4450
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Country | US
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Telephone | 718-205-9760
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Fax |
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Provider Business Mailing Address
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Address Line | 4811 QUEENS BLVD
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City | FLUSHING
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State | NY
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Zip | 11377-4450
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Country | US
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Telephone | 718-205-9760
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PUNEET RASTOGI
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Credential | OD
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Telephone | 312-925-9519
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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 |
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License Number State | NY
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