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General NPI Number Information
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NPI Number | 1659525145
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Entity Type | Organization
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Legal Business Name | FIFTH AVENUE OPTICS, INC.
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Dates
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Enumeration Date | 11/10/2008
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 1115 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10128-0100
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Country | US
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Telephone | 212-517-4500
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Fax | 212-517-4116
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Provider Business Mailing Address
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Address Line | 1115 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10128-0100
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Country | US
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Telephone | 212-517-4500
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Fax | 212-517-4116
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID GORMAN
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Credential | M.D.
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Telephone | 212-517-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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