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General NPI Number Information
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NPI Number | 1972994754
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Entity Type | Organization
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Legal Business Name | EYE D SUNSET
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Dates
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Enumeration Date | 02/14/2015
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Last Update Date | 02/14/2015
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Provider Practice Location Address
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Address Line | 4913 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11220-2890
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Country | US
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Telephone | 718-889-1921
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Fax | 718-889-1925
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Provider Business Mailing Address
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Address Line | 4913 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11220-2890
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Country | US
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Telephone | 718-889-1921
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Fax | 718-889-1925
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | MS. DIANA NGUYEN
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Credential | O.D.
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Telephone | 718-889-1921
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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 | TUV7286
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License Number State | NY
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