Healthcare Provider Details

I. General information

NPI: 1235734773
Provider Name (Legal Business Name): BRONX FAMILY EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 E 149TH ST
BRONX NY
10455-1343
US

IV. Provider business mailing address

2336 GRAND CONCOURSE
BRONX NY
10458-6903
US

V. Phone/Fax

Practice location:
  • Phone: 718-673-9337
  • Fax:
Mailing address:
  • Phone: 718-220-0439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: NIKOLAY BITSENKO
Title or Position: OWNER
Credential:
Phone: 917-499-2292