=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669778726
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JD OPTICIANS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2011
-----------------------------------------------------
Last Update Date | 02/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 152-55 10TH AVE
-----------------------------------------------------
City | WHITESTONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11357-1233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-747-2470
-----------------------------------------------------
Fax | 718-747-2477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 152-55 10TH AVE
-----------------------------------------------------
City | WHITESTONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-747-2470
-----------------------------------------------------
Fax | 718-747-2477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MATHEW DEMETRIOU
-----------------------------------------------------
Credential | OPTICIAN
-----------------------------------------------------
Telephone | 718-747-2470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------