Healthcare Provider Details

I. General information

NPI: 1235431750
Provider Name (Legal Business Name): CITI CENTER OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2010
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1182 FLATBUSH AVE
BROOKLYN NY
11226-7005
US

IV. Provider business mailing address

1182 FLATBUSH AVE
BROOKLYN NY
11226-7005
US

V. Phone/Fax

Practice location:
  • Phone: 718-495-2065
  • Fax: 718-495-2006
Mailing address:
  • Phone: 718-495-2065
  • Fax: 718-495-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: YACOUBA KONATE
Title or Position: OWNER
Credential:
Phone: 718-495-2065