=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770129181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIGITALOPTOMETRICS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2019
-----------------------------------------------------
Last Update Date | 07/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1979 MARCUS AVE STE 206
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11042-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-506-0002
-----------------------------------------------------
Fax | 516-243-8724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1979 MARCUS AVE STE 206
-----------------------------------------------------
City | NEW HYDE PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11042-1002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-506-0002
-----------------------------------------------------
Fax | 516-243-8724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | DARLENE CETTINA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 516-243-8712
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------