Provider Demographics
NPI:1841518115
Name:MSSM-OPTICAL SHOP
Entity type:Organization
Organization Name:MSSM-OPTICAL SHOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZULMA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-241-8924
Mailing Address - Street 1:17 E 102ND ST
Mailing Address - Street 2:8TH FLOOR #1183
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-5204
Mailing Address - Country:US
Mailing Address - Phone:212-824-7660
Mailing Address - Fax:212-824-2325
Practice Address - Street 1:17 E 102ND ST
Practice Address - Street 2:8TH FLOOR #1183
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5204
Practice Address - Country:US
Practice Address - Phone:212-824-7660
Practice Address - Fax:212-824-2325
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MSSM-DEPT OF OPHTHALMOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier