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General NPI Number Information
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NPI Number | 1659495570
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Entity Type | Organization
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Legal Business Name | DREAM SIGHT OPTICAL CORP.
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Dates
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Enumeration Date | 03/17/2007
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Last Update Date | 06/20/2011
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Provider Practice Location Address
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Address Line | 524 JEFFERSON PLZ
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1104
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Country | US
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Telephone | 631-476-4707
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Fax |
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Provider Business Mailing Address
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Address Line | 524 JEFFERSON PLAZA, ROUTE 112
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-1104
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Country | US
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Telephone | 631-476-4707
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Fax |
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Authorized Official
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Title or Position | OPTICIAN
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Name | MR. ROMEO V MALOCO JR.
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Credential | OPTICIAN
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Telephone | 631-476-4707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | C006424-1
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License Number State | NY
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