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General NPI Number Information
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NPI Number | 1811971203
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Entity Type | Organization
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Legal Business Name | EYEGLASS SERVICE INDUSTRIES
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 700 ROUTE 101 20
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City | MEDFORD
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State | NY
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Zip | 11763-2206
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Country | US
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Telephone | 631-924-5188
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Fax | 631-205-1034
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Provider Business Mailing Address
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Address Line | 700 ROUTE 101 20
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City | MEDFORD
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State | NY
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Zip | 11763-2206
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Country | US
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Telephone | 631-924-5188
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Fax | 631-205-1034
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRUCE TOPOL
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Credential | O.D.
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Telephone | 516-599-1135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 005020-1
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License Number State | NY
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