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General NPI Number Information
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NPI Number | 1427351485
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Entity Type | Organization
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Legal Business Name | EMANI & DIVINE EYES, INC.
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 97-04 ROCKAWAY BEACH BLVD
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693-1313
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Country | US
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Telephone | 718-474-0064
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Fax |
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Provider Business Mailing Address
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Address Line | 97-04 ROCKAWAY BEACH BLVD
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City | ROCKAWAY BEACH
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State | NY
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Zip | 11693-1313
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Country | US
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Telephone | 718-474-0064
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. HOWARD RANDOLPH ELLISON
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Credential |
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Telephone | 917-291-2370
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 0066601
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 008765
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License Number State | NY
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