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General NPI Number Information
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NPI Number | 1922075423
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Entity Type | Organization
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Legal Business Name | NORTHPORT OPTICAL CENTER INC.
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 834 FORT SALONGA RD
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City | NORTHPORT
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State | NY
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Zip | 11768-3157
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Country | US
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Telephone | 631-757-4440
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Fax | 631-757-4593
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Provider Business Mailing Address
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Address Line | 834 FORT SALONGA RD
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City | NORTHPORT
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State | NY
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Zip | 11768-3157
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Country | US
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Telephone | 631-757-4440
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Fax | 631-757-4593
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL TANENBAUM
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Credential | O.D.
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Telephone | 631-757-4440
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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 | TUV003407
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License Number State | NY
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