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General NPI Number Information
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NPI Number | 1689766073
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Entity Type | Organization
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Legal Business Name | FAMILY OPTICAL LTD
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 374 NEW YORK AVE
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City | HUNTINGTON
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State | NY
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Zip | 11743-3316
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Country | US
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Telephone | 631-421-0250
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Fax | 631-421-0827
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Provider Business Mailing Address
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Address Line | 374 NEW YORK AVE
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City | HUNTINGTON
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State | NY
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Zip | 11743-3316
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Country | US
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Telephone | 631-421-0250
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Fax | 631-421-0827
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RALPH KORNBLATT
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Credential | OD
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Telephone | 631-421-0250
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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 | 2358
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License Number State | NY
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