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General NPI Number Information
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NPI Number | 1710095153
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Entity Type | Organization
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Legal Business Name | Q GARDENS HILLS OPTICAL CENTER INC
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 01/17/2008
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Provider Practice Location Address
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Address Line | 72-59 KISSENA BLVD
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City | FLUSHING
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State | NY
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Zip | 11367
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Country | US
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Telephone | 718-263-2020
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Fax | 718-263-2028
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Provider Business Mailing Address
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Address Line | 72-59 KISSENA BLVD
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City | FLUSHING
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State | NY
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Zip | 11367
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Country | US
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Telephone | 718-263-2020
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Fax | 718-263-2028
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Authorized Official
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Title or Position | PRESIDENT OPTICIAN
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Name | MR. MARK ALLAN DUBIN
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Credential | OPTICIAN
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Telephone | 718-263-2020
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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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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State |
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