Individual
JAGMOHAN WALIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
25 OLD SHORE RD, PORT WASHINGTON, NY 11050-2222
(516) 944-5509
(516) 944-5508
Mailing address
25 OLD SHORE RD, PORT WASHINGTON, NY 11050-2222
(516) 944-5509
(516) 944-5508
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
006426
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02190081
—
NY
Enumeration date
08/05/2006
Last updated
07/08/2007
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