Healthcare Provider Details

I. General information

NPI: 1225226798
Provider Name (Legal Business Name): LAXMI AMERICAN OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83-16 NORTHERN BLVD
JACKSON HEIGHTS NY
11372
US

IV. Provider business mailing address

83-16 NORTHERN BLVD
JACKSON HEIGHTS NY
11372
US

V. Phone/Fax

Practice location:
  • Phone: 718-335-2240
  • Fax:
Mailing address:
  • Phone: 718-335-2240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. VIKAS KUMAR
Title or Position: OWNER
Credential:
Phone: 718-335-2240