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General NPI Number Information
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NPI Number | 1982156535
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Entity Type | Organization
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Legal Business Name | VISUAL OPHTHALMOLOGY SERVICES, PC
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Dates
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Enumeration Date | 10/31/2016
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 5548 96TH ST
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City | CORONA
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State | NY
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Zip | 11368-3009
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Country | US
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Telephone | 718-271-4472
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Fax | 718-271-3011
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Provider Business Mailing Address
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Address Line | 5548 96TH ST
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City | CORONA
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State | NY
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Zip | 11368-3009
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Country | US
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Telephone | 718-271-4472
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Fax | 718-271-3011
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PANUS ROMSAITONG
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Credential | MD
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Telephone | 718-271-4472
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS0132X
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Taxonomy Name | Ophthalmologic Surgery Clinic/Center
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License Number | 209009
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License Number State | NY
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