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General NPI Number Information
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NPI Number | 1114244563
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Entity Type | Organization
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Legal Business Name | BRONX VISTASITE EYECARE INC
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 11/01/2023
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Provider Practice Location Address
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Address Line | 2204 BARTOW AVE
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City | BRONX
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State | NY
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Zip | 10475-4616
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Country | US
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Telephone | 718-324-2020
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Fax | 347-843-0443
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Provider Business Mailing Address
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Address Line | 2100 BARTON AVE # 204
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City | BRONX
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State | NY
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Zip | 10475
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Country | US
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Telephone | 917-699-5876
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. OLEG LISITYSN
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Credential | OD
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Telephone | 718-324-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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