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General NPI Number Information
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NPI Number | 1598057325
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Entity Type | Organization
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Legal Business Name | OPTICAL WORLD
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 05/12/2011
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Provider Practice Location Address
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Address Line | 684 MYRTLE AVE
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City | BROOKLYN
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State | NY
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Zip | 11205-3915
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Country | US
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Telephone | 718-522-1070
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Fax | 718-633-1094
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Provider Business Mailing Address
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Address Line | 684 MYRTLE AVE
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City | BROOKLYN
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State | NY
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Zip | 11205-3915
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Country | US
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Telephone | 718-522-1070
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Fax | 718-633-1094
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. BARRY STROH
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Credential |
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Telephone | 718-522-1070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | C003719-1
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License Number State | NY
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