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General NPI Number Information
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NPI Number | 1881806917
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Entity Type | Organization
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Legal Business Name | JACKSON HEIGHTS OPTICAL INC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 83-25 37TH AVENUE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372
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Country | US
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Telephone | 718-426-2725
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Fax | 718-426-9748
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Provider Business Mailing Address
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Address Line | 58-27 198 STREET
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City | FRESH MEADOWS
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State | NY
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Zip | 11365
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Country | US
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Telephone | 718-224-0315
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Fax | 718-426-9748
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Authorized Official
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Title or Position | OWNER
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Name | MR. ISAIAS LOPE
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Credential |
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Telephone | 718-426-2725
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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 | TUV005864-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV007098-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV006744-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 006945-1
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | VUT005856
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License Number State | NY
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