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General NPI Number Information
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NPI Number | 1609055581
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Entity Type | Organization
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Legal Business Name | ATLANTIC OPTICAL, INC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 139 FLATBUSH AVE #15
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City | BROOKLYN
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State | NY
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Zip | 11217-1450
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Country | US
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Telephone | 718-522-3737
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Fax | 718-522-3894
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Provider Business Mailing Address
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Address Line | 139 FLATBUSH AVE #15
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City | BROOKLYN
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State | NY
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Zip | 11217-1450
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Country | US
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Telephone | 718-522-3737
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Fax | 718-522-3894
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALLA DYATLOV
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Credential | OPTICIAN
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Telephone | 718-522-3737
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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 | TUV006692
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License Number State | NY
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