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General NPI Number Information
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NPI Number | 1417920042
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Entity Type | Organization
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Legal Business Name | MIRKIN VISION CARE PC
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Dates
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Enumeration Date | 02/13/2006
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 253 BEACH 116TH ST
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2102
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Country | US
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Telephone | 718-634-0005
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Fax | 718-474-2003
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Provider Business Mailing Address
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Address Line | 253 BEACH 116TH ST
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City | ROCKAWAY PARK
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State | NY
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Zip | 11694-2102
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Country | US
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Telephone | 718-634-0005
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Fax | 718-474-2003
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Authorized Official
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Title or Position | PRESIDENT
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Name | PROF. DANIEL S MIRKIN
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Credential | O.D.
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Telephone | 718-634-0005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | VUT004688
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | VUT004688
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 004688
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License Number State | NY
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