Individual
DR. BRIAN STEPHEN CORNWALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
6130A 190TH ST, FRESH MEADOWS, NY 11365-2721
(718) 454-8484
Mailing address
6130A 190TH ST, FRESH MEADOWS, NY 11365-2721
(718) 454-8484
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4273-1
NY
Other
Enumeration date
12/08/2006
Last updated
07/08/2007
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