Healthcare Provider Details

I. General information

NPI: 1215376199
Provider Name (Legal Business Name): ENVISION OPTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 FLUSHING AVE UNIT 1C
BROOKLYN NY
11205-1688
US

IV. Provider business mailing address

505 FLUSHING AVE UNIT 1C
BROOKLYN NY
11205-1688
US

V. Phone/Fax

Practice location:
  • Phone: 718-522-3332
  • Fax: 718-522-3319
Mailing address:
  • Phone: 718-522-3332
  • Fax: 718-522-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JOEL LEFKOWITZ
Title or Position: OWNER
Credential:
Phone: 718-522-3332