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General NPI Number Information
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NPI Number | 1649943150
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Entity Type | Individual
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Provider Name | JEREMY DU OD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2021
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Last Update Date | 07/29/2021
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Provider Practice Location Address
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Address Line | 329 E 149TH ST FL 2
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City | BRONX
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State | NY
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Zip | 10451-5626
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Country | US
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Telephone | 888-212-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 4261 HUNTER ST APT 4R
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City | LONG ISLAND CITY
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State | NY
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Zip | 11101-4128
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Country | US
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Telephone |
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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 | 009370
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License Number State | NY
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