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General NPI Number Information
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NPI Number | 1902225170
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Entity Type | Organization
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Legal Business Name | EYEWORKS OF LYNBROOK INC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 601 SUNRISE HWY
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City | LYNBROOK
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State | NY
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Zip | 11563-3246
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Country | US
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Telephone | 516-599-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 601 SUNRISE HWY
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City | LYNBROOK
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State | NY
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Zip | 11563-3246
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED/OPTICIAN
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Name | MARK ROMANOVSKY
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Credential | ABO
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Telephone | 516-599-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State | CA
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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 |
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License Number State | NY
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