Healthcare Provider Details

I. General information

NPI: 1083711501
Provider Name (Legal Business Name): HOLLIS VISION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2006
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 FRANCIS LEWIS BLVD
QUEENS VILLAGE NY
11427-2867
US

IV. Provider business mailing address

8787 FRANCIS LEWIS BLVD
QUEENS VILLAGE NY
11427-2867
US

V. Phone/Fax

Practice location:
  • Phone: 718-465-4999
  • Fax: 718-217-6101
Mailing address:
  • Phone: 718-465-4999
  • Fax: 718-217-6101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberC005878-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number006379
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberC005878-1
License Number StateNY

VIII. Authorized Official

Name: MS. STACEY J HANAI
Title or Position: OWNER
Credential: OPTICIAN
Phone: 718-465-4999