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General NPI Number Information
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NPI Number | 1629113865
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Entity Type | Organization
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Legal Business Name | MBD OPTICAL INC.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 08/22/2013
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Provider Practice Location Address
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Address Line | 2365 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-2027
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Country | US
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Telephone | 516-796-3800
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Fax | 516-796-3802
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Provider Business Mailing Address
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Address Line | 2365 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-2027
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Country | US
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Telephone | 516-796-3800
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Fax | 516-796-3802
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Authorized Official
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Title or Position | OWNER
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Name | PAUL HANS
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Credential | OD
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Telephone | 516-681-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 003981
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License Number State | NY
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