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General NPI Number Information
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NPI Number | 1467679332
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Entity Type | Organization
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Legal Business Name | LIBERTY OPTICAL GALLERY INC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 09/16/2008
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Provider Practice Location Address
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Address Line | 1949 STATE ROUTE 52
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City | LIBERTY
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State | NY
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Zip | 12754-8313
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Country | US
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Telephone | 845-292-3160
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Fax | 845-292-3395
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Provider Business Mailing Address
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Address Line | 1949 STATE ROUTE 52
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City | LIBERTY
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State | NY
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Zip | 12754-8313
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Country | US
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Telephone | 845-292-3160
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Fax | 845-292-3395
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSEPH NUGENT
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Credential |
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Telephone | 845-292-3160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 006842
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License Number State | NY
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