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General NPI Number Information
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NPI Number | 1710158209
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Entity Type | Organization
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Legal Business Name | CHAPPAQUA EYECARE OPTOMETRY PC
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Dates
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Enumeration Date | 03/12/2008
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 22 S GREELEY AVE
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City | CHAPPAQUA
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State | NY
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Zip | 10514-3311
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Country | US
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Telephone | 914-238-5600
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Fax | 914-238-5617
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Provider Business Mailing Address
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Address Line | 22 S GREELEY AVE
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City | CHAPPAQUA
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State | NY
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Zip | 10514-3311
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Country | US
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Telephone | 914-238-5600
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Fax | 914-238-5617
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Authorized Official
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Title or Position | OD/OWNER
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Name | CHRIS GENTILE
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Credential | OD
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Telephone | 914-238-5600
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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 | TUV005961-1
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License Number State | NY
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