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General NPI Number Information
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NPI Number | 1770761686
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Entity Type | Organization
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Legal Business Name | KNAUF OPTICAL
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 03/25/2008
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Provider Practice Location Address
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Address Line | 235 VESTAL AVE
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City | ENDICOTT
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State | NY
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Zip | 13760-4928
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Country | US
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Telephone | 607-748-0765
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Fax | 607-748-0765
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Provider Business Mailing Address
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Address Line | 235 VESTAL AVE
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City | ENDICOTT
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State | NY
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Zip | 13760-4928
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Country | US
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Telephone | 607-748-0765
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Fax | 607-748-0765
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Authorized Official
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Title or Position | OWNER/PARTNER
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Name | MR. RUSSELL JOHN AVERY SR.
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Credential | LICENSED OPTICIAN
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Telephone | 607-748-0765
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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 | NY6965
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License Number State | NY
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