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General NPI Number Information
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NPI Number | 1699781351
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Entity Type | Organization
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Legal Business Name | NY EYE CARE OPTOMETRY PLLC
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 12/03/2007
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Provider Practice Location Address
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Address Line | 1758 BRENTWOOD RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-5522
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Country | US
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Telephone | 631-231-2073
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Fax | 631-231-2008
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Provider Business Mailing Address
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Address Line | 1758 BRENTWOOD RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-5522
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Country | US
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Telephone | 631-231-2073
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Fax | 631-231-2008
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. VIVIAN LEE RENTA
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Credential | OD
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Telephone | 631-231-2073
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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 |
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License Number State |
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