Organization
INNOVATIVE FIRMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA MORENO (OPTICIAN)
(718) 204-8630
Entity
Organization
Contact information
Practice address
2503 BROADWAY, ASTORIA, NY 11106-3413
(718) 204-8630
Mailing address
2503 BROADWAY, ASTORIA, NY 11106-3413
(718) 204-8630
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
008114-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02533448
—
NY
Enumeration date
02/22/2008
Last updated
02/22/2008
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