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General NPI Number Information
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NPI Number | 1881020931
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Entity Type | Organization
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Legal Business Name | BAYBRIDGE OPTICAL VISUAL EYES OPTICAL OPTIONS INC.
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Dates
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Enumeration Date | 09/20/2013
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Last Update Date | 09/20/2013
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Provider Practice Location Address
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Address Line | 20836 CROSS ISLAND PKWY
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City | BAYSIDE
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State | NY
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Zip | 11360-1187
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Country | US
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Telephone | 718-224-1833
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Fax | 718-224-1877
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Provider Business Mailing Address
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Address Line | 20836 CROSS ISLAND PKWY
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City | BAYSIDE
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State | NY
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Zip | 11360-1187
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Country | US
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Telephone | 718-224-1833
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Fax | 718-224-1877
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Authorized Official
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Title or Position | PRESIDENT 9OWNER)
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Name | MADELYN GONZALEZ
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Credential |
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Telephone | 718-224-1833
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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 | 193400000X
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License Number State | NY
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