| |
655 Montauk Highway, Suite 29, East Patchogue, NY 11772 | |
(631) 447-1300 | |
(631) 447-1302 |
Full Name | |
---|---|
Type | Facility |
Speciality | Eyewear Supplier |
Location | 655 Montauk Highway, East Patchogue, New York |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1316095482 | NPI | - | NPPES |
5400044 | Other | NY | GHI |
333670 | Other | NVA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | VUT003894 (New York) | Secondary |
332H00000X | Eyewear Supplier | 5877-1 (New York) | Primary |
Mailing Address | Practice Location Address |
---|---|
655 Montauk Hwy, Suite 29, East Patchogue, NY 11772-4733 Ph: (631) 447-1300 | 655 Montauk Highway, Suite 29, East Patchogue, NY 11772 Ph: (631) 447-1300 |