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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