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General NPI Number Information
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NPI Number | 1639258148
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Entity Type | Organization
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Legal Business Name | HERALD SQUARE OPTOMETRIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 901 AVENUE OF THE AMERICAS MANHATTAN MALL, LEVEL C-2, INSIDE LENSCRAFTERS
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City | NEW YORK
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State | NY
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Zip | 10001-3505
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Country | US
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Telephone | 212-967-4177
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Fax | 212-967-2101
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Provider Business Mailing Address
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Address Line | 901 AVENUE OF THE AMERICAS MANHATTAN MALL, LEVEL C-2, INSIDE LENSCRAFTERS
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City | NEW YORK
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State | NY
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Zip | 10001-3505
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Country | US
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Telephone | 212-967-4177
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Fax | 212-967-2101
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Authorized Official
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Title or Position | VP
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Name | DR. ELLEN J BRAND
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Credential | O.D.
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Telephone | 212-967-4177
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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 | TUV-5241
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License Number State | NY
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