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Organization

SIOC@BAY ST OPTICAL PAVILION

Active
Other names
Bay Street Optical Pavilion
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CAROLYN ROSEMARY POWELL RIVERS OD (PRINCIPLE)
(718) 727-5678
Entity
Organization

Contact information

Practice address
664 BAY ST, OPTICAL, STATEN ISLAND, NY 10304-3829
(718) 727-5678
Mailing address
664 BAY ST, OPTICAL, STATEN ISLAND, NY 10304-3829

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV004813-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01065163
NY
Enumeration date
04/10/2008
Last updated
04/10/2008
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