| |
1092 Route 112, Port Jefferson Station, NY 11776-3043 | |
(631) 474-3937 | |
(631) 474-3966 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 1092 Route 112, Port Jefferson Station, New York |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1295915528 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | (* (Not Available)) | Secondary |
332H00000X | Eyewear Supplier | (* (Not Available)) | Primary |
Mailing Address | Practice Location Address |
---|---|
312 Springfield Ave Ste 103, Berkeley Heights, NJ 07922-1277 Ph: (908) 336-5661 | 1092 Route 112, Port Jefferson Station, NY 11776-3043 Ph: (631) 474-3937 |