Individual
DR. EVAN CHRIS CANELLOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
800 POLY PL, BROOKLYN, NY 11209-7104
(718) 836-6600
Mailing address
179 ROBBY LN, MANHASSET HILLS, NY 11040-1105
(516) 365-5012
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD0000002412
TN
152W00000X
Optometrist
Primary
VUT006229
NY
Other
Enumeration date
05/18/2006
Last updated
05/25/2011
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