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General NPI Number Information
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NPI Number | 1962746693
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Entity Type | Organization
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Legal Business Name | OPHTHALMIC CONSULTANT, PLLC
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 06/04/2015
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Provider Practice Location Address
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Address Line | 134-43 MAPLE AVENUE SUITE 1C
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City | FLUSHING
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State | NY
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Zip | 11355
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Country | US
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Telephone | 718-886-8830
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Fax | 718-886-8825
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Provider Business Mailing Address
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Address Line | 81-30 254TH STREET
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City | FLORAL PARK
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State | NY
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Zip | 11004
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Country | US
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Telephone | 718-886-8830
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Fax | 718-886-8825
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Authorized Official
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Title or Position | DIRECTOR
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Name | TUNG T CHU
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Credential | MD
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Telephone | 718-886-8830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 211188
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License Number State | NY
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