Organization
INNOVATIVE FIRMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA MORENO (OPTICAN)
(718) 424-5500
Entity
Organization
Contact information
Practice address
8006 37TH AVE, JACKSON HTS, NY 11372-6720
(718) 424-5500
Mailing address
8006 37TH AVE, JACKSON HTS, NY 11372-6720
(718) 424-5500
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
8114-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02533448
—
NY
Enumeration date
02/20/2008
Last updated
02/20/2008
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