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General NPI Number Information
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NPI Number | 1649036401
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Entity Type | Individual
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Provider Name | JOSE RAUL CORDOVA OD
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Gender | Male
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Dates
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Enumeration Date | 02/27/2024
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 1979 MARCUS AVE STE 206
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1002
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Country | US
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Telephone | 516-243-8711
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Fax |
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Provider Business Mailing Address
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Address Line | 16075 NW 64TH AVE APT 108
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City | MIAMI LAKES
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State | FL
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Zip | 33014-7529
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Country | US
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Telephone | 786-285-7557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 1100
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License Number State | NH
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