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Organization

BURNSIDE OPTICAL INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
GUILLERMO YSMAEL REYES (PRESIDENT)
(718) 299-5454
Entity
Organization

Contact information

Practice address
54 W BURNSIDE AVE, BRONX, NY 10453-4018
(718) 299-5454
(718) 299-0770
Mailing address
54 W BURNSIDE AVE, BRONX, NY 10453-4018
(718) 299-5454
(718) 299-0770

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
0073791
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01956270
NY
Enumeration date
12/01/2006
Last updated
03/05/2012
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