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General NPI Number Information
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NPI Number | 1922237866
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Entity Type | Organization
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Legal Business Name | OLIVOS OPTICIANS INC
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 03/30/2010
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Provider Practice Location Address
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Address Line | 7508 37TH AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6538
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Country | US
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Telephone | 718-476-1458
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Fax | 718-476-1462
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Provider Business Mailing Address
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Address Line | 7508 37TH AVE
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6538
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Country | US
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Telephone | 718-476-1458
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Fax | 718-476-1462
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE A GOMEZ
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Credential | O.D.
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Telephone | 718-476-1458
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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 | VUT6417
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License Number State | NY
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