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General NPI Number Information
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NPI Number | 1427429000
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Entity Type | Organization
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Legal Business Name | NEW WOODSIDE OPTICAL CORP
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Dates
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Enumeration Date | 10/08/2015
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Last Update Date | 10/08/2015
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Provider Practice Location Address
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Address Line | 4811 QUEENS BLVD
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City | WOODSIDE
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State | NY
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Zip | 11377-4450
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Country | US
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Telephone | 718-205-9760
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Fax | 718-205-9738
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Provider Business Mailing Address
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Address Line | 4811 QUEENS BLVD
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City | WOODSIDE
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State | NY
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Zip | 11377-4450
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Country | US
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Telephone | 718-205-9760
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Fax | 718-205-9738
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Authorized Official
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Title or Position | OWNER, PRESIDENT
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Name | DR. MARIA KATSEV
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Credential | OD
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Telephone | 718-205-9760
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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 | TUV006380
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License Number State | NY
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