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Individual

MR. GANT GILBERT SOOHOO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OPTICAN

Contact information

Practice address
601 PORTION RD STE 14, RONKONKOMA, NY 11779-4584
(631) 648-9488
(631) 648-9487
Mailing address
601 PORTION RD STE 14, RONKONKOMA, NY 11779-4584
(631) 648-9488
(631) 648-9487

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
4191
NY

Other

Enumeration date
03/22/2007
Last updated
11/20/2009
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