Healthcare Provider Details

I. General information

NPI: 1386567758
Provider Name (Legal Business Name): FABULOUS OPTICAL OF LI CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 GREEN ACRES MALL STE 66A
VALLEY STREAM NY
11581-1545
US

IV. Provider business mailing address

2034 GREEN ACRES MALL STE 66A
VALLEY STREAM NY
11581-1545
US

V. Phone/Fax

Practice location:
  • Phone: 347-379-0023
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MARK BARAYEV
Title or Position: OWNER
Credential:
Phone: 646-321-5802