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General NPI Number Information
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NPI Number | 1427133289
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Entity Type | Organization
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Legal Business Name | SPECIAL EYES LLC
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 2791 RICHMOND AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-5859
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Country | US
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Telephone | 718-494-9257
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Fax | 718-494-4183
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Provider Business Mailing Address
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Address Line | 2791 RICHMOND AVENUE
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City | STATEN ISLAND
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State | NY
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Zip | 10314
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Country | US
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Telephone | 718-494-9257
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Fax | 718-494-4183
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Authorized Official
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Title or Position | OPTICIAN
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Name | SALVATORE TARANTOLA
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Credential |
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Telephone | 718-494-9257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | C0038731
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV0045731
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License Number State | NY
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