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General NPI Number Information
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NPI Number | 1720294713
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Entity Type | Organization
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Legal Business Name | MIYAGI ISLAND OPTICAL INC
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 910 NEW YORK AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310
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Country | US
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Telephone | 505-434-0036
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Fax | 505-434-0036
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Provider Business Mailing Address
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Address Line | 910 NEW YORK AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310
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Country | US
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Telephone | 505-434-0036
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Fax | 505-434-0036
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MR. JAMES A MIYAGISHIMA
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Credential | BS AA FNAD
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Telephone | 505-434-0036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | CERTIFICATE00750
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License Number State |
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