Healthcare Provider Details

I. General information

NPI: 1902225170
Provider Name (Legal Business Name): EYEWORKS OF LYNBROOK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SUNRISE HWY
LYNBROOK NY
11563-3246
US

IV. Provider business mailing address

601 SUNRISE HWY
LYNBROOK NY
11563-3246
US

V. Phone/Fax

Practice location:
  • Phone: 516-599-8181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateCA

VIII. Authorized Official

Name: MARK ROMANOVSKY
Title or Position: LICENSED/OPTICIAN
Credential: ABO
Phone: 516-599-8181