Healthcare Provider Details

I. General information

NPI: 1225210081
Provider Name (Legal Business Name): EYEWORLD OPTICAL OF QUEENS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-26 METROPOLITAN AVE
MIDDLE VILLAGE NY
11379
US

IV. Provider business mailing address

66-26 METROPOLITAN AVE
MIDDLE VILLAGE NY
11379
US

V. Phone/Fax

Practice location:
  • Phone: 718-497-8910
  • Fax: 718-497-8911
Mailing address:
  • Phone: 718-497-8910
  • Fax: 718-497-8911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTVV00033761
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number0047061
License Number StateNY

VIII. Authorized Official

Name: DR. ARTHUR B LEVIN
Title or Position: PRESIDENT EYEWORLD OPTICAL
Credential: OD
Phone: 718-497-8910