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General NPI Number Information
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NPI Number | 1659849115
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Entity Type | Organization
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Legal Business Name | PLC OPTICAL CORP
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Dates
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Enumeration Date | 11/02/2018
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 460 COUNTY ROAD 111 UNIT 8
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City | MANORVILLE
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State | NY
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Zip | 11949-3375
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Country | US
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Telephone | 917-602-4139
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Fax |
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Provider Business Mailing Address
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Address Line | 199 GOTHIC CIR
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City | MANORVILLE
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State | NY
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Zip | 11949-2622
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Country | US
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Telephone | 917-602-4139
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PETER LACORTE
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Credential |
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Telephone | 917-602-4139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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