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Organization
WIZARD OF EYES OF 116 ST INC
Active
Organization
WIZARD OF EYES OF 116 ST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD CHAVIS (PRESIDENT/ OPTICIAN)
(212) 996-7676
Entity
Organization
Contact information
Practice address
187 E 116TH ST, NEW YORK, NY 10029-1342
(212) 996-7676
Mailing address
187 E 116TH ST, NEW YORK, NY 10029-1342
(212) 996-7676
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
156FX1800X
Optician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01181057
—
NY
01
—
A100133294
MEDICARE PTAN
NY
Enumeration date
08/28/2006
Last updated
02/15/2016
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