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General NPI Number Information
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NPI Number | 1962541516
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Entity Type | Organization
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Legal Business Name | FOR EYES OPTICAL OF PA
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 01/29/2008
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Provider Practice Location Address
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Address Line | 420 LEXINGTON AVE
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City | NEW YORK
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State | NY
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Zip | 10170-0002
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Country | US
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Telephone | 212-697-8888
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Fax |
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Provider Business Mailing Address
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Address Line | 285 W 74TH PL
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City | HIALEAH
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State | FL
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Zip | 33014-5058
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP
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Name | JEFFRY MARTIN
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Credential |
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Telephone | 305-557-9004
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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 | 007787-1
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License Number State | NY
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