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General NPI Number Information
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NPI Number | 1568503886
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Entity Type | Organization
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Legal Business Name | OPTICAL ILLUSIONS OF YORKTOWN, INC.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 07/27/2009
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Provider Practice Location Address
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Address Line | 78 BROOKSIDE AVE, SUITE 2
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City | CHESTER
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State | NY
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Zip | 10918-1059
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Country | US
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Telephone | 914-469-5161
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Fax | 914-469-5761
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Provider Business Mailing Address
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Address Line | 3630 HILL BLVD, SUITE 203
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City | JEFFERSON VALLEY
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State | NY
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Zip | 10535-1502
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Country | US
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Telephone | 914-245-5151
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Fax | 914-245-7157
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Authorized Official
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Title or Position | OWNER
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Name | MR. RAYMOND KOLKMANN
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Credential | OPTICIAN
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Telephone | 914-245-5151
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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 |
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License Number State |
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