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General NPI Number Information
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NPI Number | 1932249083
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Entity Type | Organization
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Legal Business Name | IZE OPTIC INC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 59 PAGE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2611
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Country | US
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Telephone | 718-948-9088
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Fax |
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Provider Business Mailing Address
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Address Line | 59 PAGE AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10309-2611
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Country | US
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Telephone | 718-948-9088
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. ELIZABETH PORSHAY
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Credential |
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Telephone | 718-948-9682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 007028
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License Number State | NY
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