=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821161944
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTWAY VISION, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 02/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 756 10TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-245-0686
-----------------------------------------------------
Fax | 212-245-6305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 756 10TH AVE
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10019-5002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-245-0686
-----------------------------------------------------
Fax | 212-245-6305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | HENRY TANZIL
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 212-245-0686
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 005033
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------