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MR. HOWARD RANDOLPH ELLISON II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OPTICIAN

Contact information

Practice address
132 E FORDHAM RD, BRONX, NY 10468-5408
(718) 561-1600
(718) 561-1611
Mailing address
132 E FORDHAM RD, BRONX, NY 10468-5408
(718) 561-1600
(718) 561-1611

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
008765
NY

Other

Enumeration date
09/09/2010
Last updated
09/09/2010
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