| NPI | 1427351485 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOWARD RANDOLPH ELLISON Optician 917-291-2370 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: NY 008765) |
| Additional Taxonomies | 305S00000X Point of Service (Licence: NY 0066601) |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |