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General NPI Number Information
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NPI Number | 1689707457
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Entity Type | Organization
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Legal Business Name | COLUMBIA OPTICIANS INC
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1246 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10027-5924
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Country | US
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Telephone | 212-316-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 1246 AMSTERDAM AVE
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City | NEW YORK
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State | NY
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Zip | 10027-5924
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Country | US
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Telephone | 212-316-2020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDY ROTH
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Credential |
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Telephone | 212-316-2020
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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 | 4351
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License Number State | NY
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