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General NPI Number Information
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NPI Number | 1851467955
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Entity Type | Organization
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Legal Business Name | MT. SINAI OPTICAL
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5507 NESCONSET HWY SUITE 24
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City | MOUNT SINAI
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State | NY
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Zip | 11766-2031
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Country | US
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Telephone | 631-474-1616
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Fax | 631-474-2092
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Provider Business Mailing Address
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Address Line | 5507 NESCONSET HWY SUITE 24
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City | MOUNT SINAI
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State | NY
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Zip | 11766-2031
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Country | US
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Telephone | 631-474-1616
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Fax | 631-474-2092
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PAMELA J. KRIEGER
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Credential | LDO
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Telephone | 631-474-1616
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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 | TUV005594-1
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License Number State | NY
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