Organization
EMANI & DIVINE EYES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. HOWARD RANDOLPH ELLISON (OPTICIAN)
(917) 291-2370
Entity
Organization
Contact information
Practice address
97-04 ROCKAWAY BEACH BLVD, ROCKAWAY BEACH, NY 11693-1313
(718) 474-0064
Mailing address
97-04 ROCKAWAY BEACH BLVD, ROCKAWAY BEACH, NY 11693-1313
(718) 474-0064
Taxonomy
Speciality
Code
Description
License number
State
305S00000X
Point of Service
0066601
NY
305S00000X
Point of Service
Primary
008765
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023325107
—
NY
Enumeration date
12/14/2010
Last updated
12/14/2010
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