Individual
JET THANETR RUTTANASEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7010 AUSTIN ST STE 2, FOREST HILLS, NY 11375-4763
(718) 575-8288
Mailing address
11035 72ND RD, APT. 605, FOREST HILLS, NY 11375-5471
(347) 901-0183
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV 007165
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03086528
—
NY
Enumeration date
09/20/2007
Last updated
02/02/2021
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