Healthcare Provider Details

I. General information

NPI: 1164518577
Provider Name (Legal Business Name): E&I OPTICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1723 AVENUE U
BROOKLYN NY
11229-3811
US

IV. Provider business mailing address

1723 AVENUE U
BROOKLYN NY
11229-3811
US

V. Phone/Fax

Practice location:
  • Phone: 718-998-8400
  • Fax: 718-998-2500
Mailing address:
  • Phone: 718-998-8400
  • Fax: 718-998-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT006198
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number007691-1
License Number StateNY

VIII. Authorized Official

Name: MR. IGOR VALERY SUPITSKIY
Title or Position: PRESIDENT
Credential: OPTICIAN
Phone: 718-998-8400