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General NPI Number Information
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NPI Number | 1922160886
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Entity Type | Individual
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Provider Name | GWEN APRIL HAUSMAN OD
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Gender | Female
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | SHADES OF GRAHAM 2 GRAHAM AVE
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City | BROOKLYN
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State | NY
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Zip | 11206
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Country | US
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Telephone | 718-963-1177
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Fax | 718-963-3511
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Provider Business Mailing Address
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Address Line | 208 EAST BROADWAY #J1203
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City | NEW YORK
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State | NY
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Zip | 10002
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Country | US
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Telephone | 917-297-8031
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Fax | 212-228-8841
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | TUV005742
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License Number State | NY
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