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General NPI Number Information
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NPI Number | 1396803110
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Entity Type | Organization
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Legal Business Name | EASTSIDE OPTOMETRIC, P.C.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 425 LEXINGTON AVE EASTSIDE OPTOMETRIC, P.C. CO LENSCRAFTERS
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City | NEW YORK
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State | NY
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Zip | 10017-3903
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Country | US
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Telephone | 212-986-9281
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Fax | 212-681-6102
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Provider Business Mailing Address
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Address Line | 425 LEXINGTON AVE EASTSIDE OPTOMETRIC, P.C. CO LENSCRAFTERS
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City | NEW YORK
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State | NY
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Zip | 10017-3903
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Country | US
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Telephone | 212-986-9281
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Fax | 212-681-6102
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT GOLDBERG
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Credential | O.D.
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Telephone | 212-986-9281
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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 | TUV003814
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License Number State | NY
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