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General NPI Number Information
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NPI Number | 1871519496
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Entity Type | Organization
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Legal Business Name | GALLERIA OPTIQUE
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 25313 NORTHERN BLVD
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City | LITTLE NECK
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State | NY
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Zip | 11362-1458
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Country | US
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Telephone | 718-352-4900
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Fax | 718-352-5087
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Provider Business Mailing Address
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Address Line | 25313 NORTHERN BLVD
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City | LITTLE NECK
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State | NY
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Zip | 11362-1458
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Country | US
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Telephone | 718-352-4900
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Fax | 718-352-5087
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Authorized Official
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Title or Position | DOCTOR
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Name | JIYOUNG YOON
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Credential | O.D
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Telephone | 718-352-4900
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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 | TUV006830
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License Number State | NY
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