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General NPI Number Information
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NPI Number | 1710936059
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Entity Type | Organization
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Legal Business Name | SOUTH SHORE OPTOMETRIC ASSOCIATES, PC
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 202 BROADWAY
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City | AMITYVILLE
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State | NY
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Zip | 11701-2797
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Country | US
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Telephone | 631-264-3937
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Fax | 631-598-4496
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Provider Business Mailing Address
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Address Line | 202 BROADWAY
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City | AMITYVILLE
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State | NY
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Zip | 11701-2727
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Country | US
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Telephone | 631-264-3937
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Fax | 631-598-4496
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAVID LANE LEIBSTEIN
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Credential | O.D.
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Telephone | 631-264-3937
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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 | TUV005756-1
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License Number State | NY
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