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General NPI Number Information
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NPI Number | 1649545492
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Entity Type | Organization
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Legal Business Name | MICHELLE'S OPTICAL INC
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Dates
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Enumeration Date | 03/13/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 4101 KISSENA BLVD
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City | FLUSHING
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State | NY
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Zip | 11355-3138
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Country | US
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Telephone | 718-321-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 KISSENA BLVD
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City | FLUSHING
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State | NY
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Zip | 11355-3138
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Country | US
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Telephone | 718-321-1212
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. DANIEL KUNG
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Credential |
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Telephone | 718-321-1212
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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 | TUV006580
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License Number State | NY
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