Healthcare Provider Details

I. General information

NPI: 1184996001
Provider Name (Legal Business Name): COSMOS TOTAL OPTOMETRY CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date: 10/27/2015
Reactivation Date: 04/18/2016

III. Provider practice location address

9001 ROOSEVELT AVE
JACKSON HEIGHTS NY
11372-7938
US

IV. Provider business mailing address

9001 ROOSEVELT AVE
JACKSON HEIGHTS NY
11372-7938
US

V. Phone/Fax

Practice location:
  • Phone: 718-458-8500
  • Fax: 718-424-3366
Mailing address:
  • Phone: 718-458-8500
  • Fax: 718-424-3366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV006061
License Number StateNY

VIII. Authorized Official

Name: DR. JOANNE ECONOPOULY
Title or Position: OWNER/PRESIDENT
Credential: O.D.
Phone: 718-458-8500