Healthcare Provider Details

I. General information

NPI: 1871421073
Provider Name (Legal Business Name): EYEBORN OPTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4622 AVENUE L
BROOKLYN NY
11234-3113
US

IV. Provider business mailing address

4622 AVENUE L
BROOKLYN NY
11234-3113
US

V. Phone/Fax

Practice location:
  • Phone: 718-252-6378
  • Fax:
Mailing address:
  • Phone: 718-252-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JON MITCHELL
Title or Position: OPTICIAN / OWNER
Credential:
Phone: 718-252-6378