Healthcare Provider Details

I. General information

NPI: 1447228333
Provider Name (Legal Business Name): BENSONHURST FAMILY VISION CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2142 86TH ST
BROOKLYN NY
11214-3214
US

IV. Provider business mailing address

2142 86TH ST
BROOKLYN NY
11214-3214
US

V. Phone/Fax

Practice location:
  • Phone: 718-372-5144
  • Fax: 718-373-0684
Mailing address:
  • Phone: 718-372-5144
  • Fax: 718-373-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV004810
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006252
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006545
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number005101
License Number StateNY

VIII. Authorized Official

Name: MR. WILLIAM BALDIZZONE
Title or Position: PRESIDENT
Credential:
Phone: 718-372-5144