Individual
MR. DEJUAN LAMONT WYNN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OPTICIAN
Contact information
Practice address
167 LENOX AVE, NEW YORK, NY 10026-1320
(212) 222-6100
(212) 222-6606
Mailing address
167 LENOX AVE, NEW YORK, NY 10026-1320
(212) 222-6100
(212) 222-6606
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
164759
NY
Other
Enumeration date
11/24/2007
Last updated
11/24/2007
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