Healthcare Provider Details

I. General information

NPI: 1912245572
Provider Name (Legal Business Name): EYE DEAL OPTICAL OF CO-OP CITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 BARTOW AVE
BRONX NY
10475-4615
US

IV. Provider business mailing address

2136 BARTOW AVE
BRONX NY
10475-4615
US

V. Phone/Fax

Practice location:
  • Phone: 718-618-5399
  • Fax: 718-671-9548
Mailing address:
  • Phone: 718-618-5399
  • Fax: 718-671-9548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: AVI CHOAI
Title or Position: OWNER
Credential:
Phone: 718-618-5399