Organization Name: | GRAND SPECTACLE INC. |
NPI Number: | 1215075809 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHARLES DIDONATO (OPTICIAN) |
Mailing Address: | 6660 Grand Ave Maspeth |
State: | NY US |
Postal Code: | 113782531 |
Phone Number: | 7184241924 |
Fax Number: | 7184240992 |
NPI Enumeration Date: | 02/03/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | NY3969 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |