Basic Information
| Provider Information | |||||||||
| NPI: | 1174197701 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE OPTOMETRY EYEWEAR, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 187 | ||||||||
| Address2: | |||||||||
| City: | ARMONK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105040187 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9175686231 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5 GRACE CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | PORT CHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105734911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9149378899 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2021 | ||||||||
| LastUpdateDate: | 05/18/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEE | ||||||||
| AuthorizedOfficialFirstName: | SYLVIA | ||||||||
| AuthorizedOfficialMiddleName: | KANG | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9175686231 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMPREHENSIVE OPTOMETRY EYEWEAR, PLLC | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | 05/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
No ID Information.