Individual
KAR TO IP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
451 CLARKSON AVE, BROOKLYN, NY 11203-2054
(718) 245-3325
Mailing address
8404 15TH AVE, BROOKLYN, NY 11228-3402
(718) 869-6946
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
008696
NY
Other
Enumeration date
09/24/2017
Last updated
05/28/2025
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