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General NPI Number Information
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NPI Number | 1578685806
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Entity Type | Organization
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Legal Business Name | ST. ALBANS OPTICS, INC.
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20516 LINDEN BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2926
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Country | US
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Telephone | 718-525-2200
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Fax | 718-525-2201
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Provider Business Mailing Address
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Address Line | 20516 LINDEN BLVD
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City | SAINT ALBANS
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State | NY
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Zip | 11412-2926
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Country | US
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Telephone | 718-525-2200
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Fax | 718-525-2201
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDWARD GADDY
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Credential |
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Telephone | 718-525-2200
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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 | 195772-4
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License Number State | NY
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