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General NPI Number Information
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NPI Number | 1902569072
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Entity Type | Organization
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Legal Business Name | WOODHAVEN OPTICAL LTD
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Dates
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Enumeration Date | 10/15/2021
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Last Update Date | 10/15/2021
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Provider Practice Location Address
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Address Line | 9502 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2518
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Country | US
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Telephone | 347-238-1854
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Fax | 347-238-1656
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Provider Business Mailing Address
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Address Line | 9502 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2518
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Country | US
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Telephone | 347-238-1854
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Fax | 347-238-1656
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DAVID NAZGINOV
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Credential | OPTICIAN
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Telephone | 347-285-9661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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