Healthcare Provider Details

I. General information

NPI: 1225087471
Provider Name (Legal Business Name): BAYVIEW OPTICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2006
Last Update Date: 05/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 86TH ST
BROOKLYN NY
11214-3204
US

IV. Provider business mailing address

2020 86TH ST
BROOKLYN NY
11214-3204
US

V. Phone/Fax

Practice location:
  • Phone: 718-449-7164
  • Fax:
Mailing address:
  • Phone: 718-449-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV007565
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number006939-1
License Number StateNY

VIII. Authorized Official

Name: MRS. LILIYA PILIPENKO
Title or Position: OPTICIAN
Credential:
Phone: 718-449-7164