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Organization

RALPH PLACE OPTICAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
FARZAD FAKHERI MD (PRESIDENT)
(718) 720-2001
Entity
Organization

Contact information

Practice address
11 RALPH PL, SUITE 101, STATEN ISLAND, NY 10304-4401
(718) 720-2001
Mailing address
8 RIDGEWAY DR, KINGS POINT, NY 11024-1435
(718) 720-2001

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV004573
NY
207W00000X
Ophthalmology Physician
191296
NY

Other

Enumeration date
10/31/2016
Last updated
10/31/2016
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