MEDICARE: KINGS PLAZA VISION EXPRESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1124613195
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGS PLAZA VISION EXPRESS LLC

Provider Business Mailing Address
First Line	:	5171 KINGS PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5218
Country	:	US
Telephone Number	:	718-951-9800
Fax Number	:	718-252-3736

Provider Business Practice Location Address
First Line	:	5171 KINGS PLZ
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5218
Country	:	US
Telephone Number	:	718-951-9800
Fax Number	:	718-252-3736

Authorized Official
Title or Position	:	OWNER
Name	:	LEONID VAYNER
Credential	:
Telephone Number	:	718-373-2020

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	06/06/2024

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Directions to “KINGS PLAZA VISION EXPRESS LLC ” Practice Location

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