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General NPI Number Information
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NPI Number | 1760939730
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Entity Type | Organization
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Legal Business Name | COOPERCRWN NY CORP
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 04/01/2021
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Provider Practice Location Address
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Address Line | 20939 NORTHERN BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3134
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Country | US
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Telephone | 347-502-7850
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Fax |
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Provider Business Mailing Address
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Address Line | 20939 NORTHERN BLVD
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City | BAYSIDE
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State | NY
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Zip | 11361-3134
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Country | US
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Telephone | 201-731-3587
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SEAN KIM
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Credential |
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Telephone | 201-731-3587
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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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