Healthcare Provider Details

I. General information

NPI: 1609167212
Provider Name (Legal Business Name): BARTOW AVENUE BRONX EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2011
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2075 BARTOW AVE
BRONX NY
10475-4613
US

IV. Provider business mailing address

2075 BARTOW AVE
BRONX NY
10475-4613
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-5666
  • Fax: 718-862-2306
Mailing address:
  • Phone: 718-671-5666
  • Fax: 718-862-2306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006962
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number007938
License Number StateNY

VIII. Authorized Official

Name: MS. ELAINA ZAVILENSKY
Title or Position: MGR
Credential:
Phone: 718-671-5666