Healthcare Provider Details

I. General information

NPI: 1609064153
Provider Name (Legal Business Name): QUEENS OPTOMETRIC CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 11/03/2020
Certification Date: 11/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 PELHAM PKWY N SUITE 202
BRONX NY
10467-8069
US

IV. Provider business mailing address

665 PELHAM PKWY N SUITE 202
BRONX NY
10467-8068
US

V. Phone/Fax

Practice location:
  • Phone: 718-547-2020
  • Fax: 718-547-3021
Mailing address:
  • Phone: 718-547-2020
  • Fax: 718-547-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: EUGENE ORLOFF
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 718-547-2020