Healthcare Provider Details

I. General information

NPI: 1609244698
Provider Name (Legal Business Name): HJ VISION CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2015
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115-11 LIBERTY AVENUE
SOUTH RICHMOND HILL NY
11419-1158
US

IV. Provider business mailing address

115-11 LIBERTY AVENUE
SOUTH RICHMOND HILL NY
11419-1158
US

V. Phone/Fax

Practice location:
  • Phone: 718-846-0824
  • Fax: 718-846-0801
Mailing address:
  • Phone: 718-846-0824
  • Fax: 718-846-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number007311-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JUNG KWANG PARK
Title or Position: OWNER / OPTICIAN
Credential: O.D
Phone: 718-846-0824