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General NPI Number Information
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NPI Number | 1568747186
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Entity Type | Organization
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Legal Business Name | MK2 OPTICAL,LLC
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 139 CENTRE ST UNIT# 110
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City | NEW YORK
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State | NY
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Zip | 10013-4552
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Country | US
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Telephone | 212-219-2219
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Fax |
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Provider Business Mailing Address
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Address Line | 139 CENTRE ST UNIT# 110
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City | NEW YORK
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State | NY
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Zip | 10013-4552
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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 | CEO
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Name | ELEANOR MA
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Credential |
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Telephone | 212-267-1260
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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 |
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License Number State |
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