Organization
EYESITE VISION II
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLEMENT ENORENSE IDEHEN O.D (PRESIDENT)
(718) 235-7900
Entity
Organization
Contact information
Practice address
1125 LIBERTY AVE, BROOKLYN, NY 11208-3310
(718) 235-7900
(718) 235-7909
Mailing address
1125 LIBERTY AVE, BROOKLYN, NY 11208-3310
(718) 235-7900
(718) 235-7909
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T006065
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02579106
—
NY
Enumeration date
05/26/2006
Last updated
08/22/2020
Update your record
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