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General NPI Number Information
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NPI Number | 1467501650
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Entity Type | Organization
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Legal Business Name | RIDGEWOOD OPTICAL WAREHOUSE OUTLET CORP.
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6041 MYRTLE AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5933
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Country | US
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Telephone | 718-386-2423
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Fax |
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Provider Business Mailing Address
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Address Line | 6041 MYRTLE AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-5933
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Country | US
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Telephone | 718-386-2423
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Fax |
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Authorized Official
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Title or Position | OPTICIAN,MANAGER
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Name | MR. EDWARD DAVIDOV
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Credential |
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Telephone | 718-386-2423
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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 | 07646
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License Number State | NY
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