Individual
INDIGO ENSIGN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
437 5TH AVE FL 2, NEW YORK, NY 10016-2205
(877) 852-2020
Mailing address
235 E 50TH ST APT 15, NEW YORK, NY 10022-7727
(317) 833-6044
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
009342-01
NY
Other
Enumeration date
07/09/2021
Last updated
07/09/2021
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