Organization
OPTICAL SHOP OF DEER PARK INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONID GLADSTEIN (OWNER)
(917) 887-8872
Entity
Organization
Contact information
Practice address
415 COMMACK RD STE 2B, DEER PARK, NY 11729-4508
(631) 392-0711
(631) 392-0752
Mailing address
415 COMMACK RD STE 2B, DEER PARK, NY 11729-4508
(631) 392-0711
(631) 392-0752
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
02/22/2019
Last updated
07/02/2019
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