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General NPI Number Information
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NPI Number | 1427007053
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Entity Type | Organization
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Legal Business Name | WITZ OPTICAL CORP
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 01/05/2008
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Provider Practice Location Address
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Address Line | 2303 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3918
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Country | US
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Telephone | 718-982-9602
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Fax | 718-982-9607
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Provider Business Mailing Address
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Address Line | 2303 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3918
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Country | US
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Telephone | 718-982-9602
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Fax | 718-982-9607
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NEIL COOPER
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Credential | O.D.
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Telephone | 718-982-9602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 004641
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 006692
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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 | TU003858
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License Number State | NY
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