| NPI | 1467164400 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BORIS TAKHALOV Owner 347-418-2730 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Additional Taxonomies | 152W00000X Optometrist |
| Enumeration Date | 2022-12-21 |
| Last Update Date | 2022-12-21 |