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Organization
WAVECREST OPTICAL SHOP
Active
Organization
WAVECREST OPTICAL SHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARRY RAINES (OWNER)
(718) 327-2020
Entity
Organization
Contact information
Practice address
257 BEACH 20TH ST, FAR ROCKAWAY, NY 11691-3625
(718) 327-2020
(718) 327-3429
Mailing address
257 BEACH 20TH ST, FAR ROCKAWAY, NY 11691-3625
(718) 327-2020
(718) 327-3429
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
005665
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01136483
—
NY
Enumeration date
05/30/2007
Last updated
08/16/2007
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