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General NPI Number Information
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NPI Number | 1447599105
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Entity Type | Organization
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Legal Business Name | EYES ON BROADWAY
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Dates
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Enumeration Date | 01/31/2013
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Last Update Date | 01/31/2013
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Provider Practice Location Address
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Address Line | 651 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10012-2302
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Country | US
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Telephone | 212-614-0069
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Fax | 212-614-9407
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Provider Business Mailing Address
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Address Line | 651 BROADWAY
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City | NEW YORK
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State | NY
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Zip | 10012-2302
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Country | US
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Telephone | 212-614-0069
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Fax | 212-614-9407
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Authorized Official
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Title or Position | MANAGER
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Name | ANITA OHRIKER
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Credential | OPTICIAN
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Telephone | 212-614-0069
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 8073-01
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License Number State | NY
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