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General NPI Number Information
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NPI Number | 1528294568
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Entity Type | Organization
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Legal Business Name | METRO-OPTICA EYEWEAR, INC.
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Dates
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Enumeration Date | 06/04/2009
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 11827 METROPOLITAN AVE
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City | KEW GARDENS
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State | NY
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Zip | 11415-2020
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Country | US
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Telephone | 718-850-0050
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Fax | 718-850-0056
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Provider Business Mailing Address
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Address Line | 11827 METROPOLITAN AVE
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City | KEW GARDENS
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State | NY
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Zip | 11415-2020
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Country | US
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Telephone | 718-850-0050
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Fax | 718-850-0056
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATALYA MALAKOVA
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Credential | O.D.
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Telephone | 917-680-0404
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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 | VUT006389
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License Number State | NY
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