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General NPI Number Information
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NPI Number | 1689938474
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Entity Type | Organization
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Legal Business Name | ANCHOR OPTOMETRIC CARE PC
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 06/27/2012
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Provider Practice Location Address
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Address Line | 21714 MERRICK BLVD
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City | LAURELTON
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State | NY
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Zip | 11413-1917
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Country | US
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Telephone | 718-978-0100
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Fax | 718-978-0101
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Provider Business Mailing Address
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Address Line | 21714 MERRICK BLVD
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City | LAURELTON
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State | NY
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Zip | 11413-1917
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. CHISOM IWUANYANWU
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Credential |
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Telephone | 718-723-4150
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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 | TUV007637-1
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License Number State | NY
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