Organization
BALDWIN OPTOMETRY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES J DELUCA O.D. (PRESIDENT)
(516) 223-0528
Entity
Organization
Contact information
Practice address
2429 GRAND AVE, BALDWIN, NY 11510-3219
(516) 223-0528
(516) 223-0730
Mailing address
2429 GRAND AVE, BALDWIN, NY 11510-3219
(516) 223-0528
(516) 223-0730
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
005434
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03064115
—
NY
01
—
A100042581
MEDICARE GROUP PTAN
NY
01
—
A400042587
MEDICARE MEMBER- CHARLES J DELUCA OD- PTAN
NY
Enumeration date
11/14/2007
Last updated
04/21/2011
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