Healthcare Provider Details

I. General information

NPI: 1700078086
Provider Name (Legal Business Name): ELAINA MOYSHELIS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 BROADWAY OPTICA EXPRESS
NEW YORK NY
10032-1538
US

IV. Provider business mailing address

FAMILY EYECARE LLC 515 N WOOD AVE STE 102
LINDEN NJ
07036-4173
US

V. Phone/Fax

Practice location:
  • Phone: 212-568-4693
  • Fax: 212-568-4694
Mailing address:
  • Phone: 908-259-5059
  • Fax: 908-486-5006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number007206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: