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General NPI Number Information
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NPI Number | 1992189153
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Entity Type | Organization
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Legal Business Name | EJMVKK ASSOCIATES INC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/31/2021
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Provider Practice Location Address
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Address Line | 10222 ATLANTIC AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-1739
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Country | US
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Telephone | 718-846-1144
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Fax | 347-772-3032
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Provider Business Mailing Address
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Address Line | 10222 ATLANTIC AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-1739
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Country | US
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Telephone | 718-846-1144
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Fax | 347-772-3032
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | VINCENTE A CALDERON
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Credential | OD
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Telephone | 718-749-7027
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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 | 007143
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License Number State | NY
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