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General NPI Number Information
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NPI Number | 1679629711
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Entity Type | Organization
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Legal Business Name | 786 UNITED INC.
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11104 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1812
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Country | US
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Telephone | 718-641-3450
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Fax | 718-641-3792
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Provider Business Mailing Address
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Address Line | 11104 LIBERTY AVE
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City | SOUTH RICHMOND HILL
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State | NY
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Zip | 11419-1812
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Country | US
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Telephone | 718-641-3450
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Fax | 718-641-3792
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Authorized Official
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Title or Position | MANAGER
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Name | MR. AFZAL YAKUB
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Credential |
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Telephone | 718-641-3450
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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 | TUV006453
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License Number State | NC
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