Organization
SOUTH SHORE OPTOMETRIC ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID LANE LEIBSTEIN O.D. (PRESIDENT)
(631) 264-3937
Entity
Organization
Contact information
Practice address
202 BROADWAY, AMITYVILLE, NY 11701-2797
(631) 264-3937
(631) 598-4496
Mailing address
202 BROADWAY, AMITYVILLE, NY 11701-2727
(631) 264-3937
(631) 598-4496
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
TUV005756-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03196247
—
NY
Enumeration date
05/05/2006
Last updated
05/24/2016
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