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General NPI Number Information
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NPI Number | 1962510560
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Entity Type | Organization
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Legal Business Name | NEW YORK OPTICAL OF MANHATTAN CORPORATION
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Dates
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Enumeration Date | 08/25/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 648 W 181ST ST
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City | NEW YORK
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State | NY
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Zip | 10033-3801
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Country | US
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Telephone | 212-927-4444
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Fax |
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Provider Business Mailing Address
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Address Line | 65 VILLAS CIR
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City | MELVILLE
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State | NY
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Zip | 11747-3061
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Country | US
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Telephone | 212-927-4444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WAYNE TABACHNICK
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Credential | OD
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Telephone | 212-927-4444
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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 | TUV002974
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License Number State | NY
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