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General NPI Number Information
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NPI Number | 1508129693
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Entity Type | Organization
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Legal Business Name | EXQUISITE EYE WEAR INC.
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Dates
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Enumeration Date | 06/22/2012
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 916 CARMANS RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758-3505
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Country | US
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Telephone | 917-617-0071
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Fax |
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Provider Business Mailing Address
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Address Line | 916 CARMANS RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758-3505
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YEFIM SAFIYEV
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Credential |
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Telephone | 917-617-0071
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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 | 008978-1
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License Number State | NY
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