Individual
EKSUPAR TONGSRI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
415 GRAND STREET, E1505, NEW YORK, NY 10002
(917) 664-4446
Mailing address
1594 FLATBUSH AVE, BROOKLYN, NY 11210-3030
(917) 664-4446
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV006827-1
NY
Other
Enumeration date
05/04/2009
Last updated
07/05/2019
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