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General NPI Number Information
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NPI Number | 1700042421
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Entity Type | Organization
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Legal Business Name | VISTA VISION OPTICAL, INC
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Dates
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Enumeration Date | 08/01/2008
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | 337 KNICKERBOCKER AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-3752
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Country | US
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Telephone | 718-456-2834
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Fax |
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Provider Business Mailing Address
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Address Line | 337 KNICKERBOCKER AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-3752
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Country | US
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Telephone | 718-456-2834
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID R. NATHANSON
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Credential | O.D.
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Telephone | 516-551-7844
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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 | TUV003774
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License Number State | NY
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