Healthcare Provider Details

I. General information

NPI: 1255971040
Provider Name (Legal Business Name): CITYWIDE EYE CARE OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2020
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MIDDLE NECK RD
GREAT NECK NY
11021-1219
US

IV. Provider business mailing address

35 OAK LN
NEW HYDE PARK NY
11040-2339
US

V. Phone/Fax

Practice location:
  • Phone: 718-357-4884
  • Fax:
Mailing address:
  • Phone: 718-820-2613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. LILY ZHU-TAM
Title or Position: OPTOMETRIST
Credential: OD
Phone: 718-820-2613