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General NPI Number Information
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NPI Number | 1144102351
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Entity Type | Organization
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Legal Business Name | GARDEN CITY MALL VISION EXPRESS LLC
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 630 OLD COUNTRY RD UNIT 1091A
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City | GARDEN CITY
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State | NY
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Zip | 11530-3470
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Country | US
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Telephone | 516-294-0011
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Fax |
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Provider Business Mailing Address
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Address Line | 630 OLD COUNTRY RD UNIT 1091A
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City | GARDEN CITY
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State | NY
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Zip | 11530-3470
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Country | US
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Telephone | 516-294-0011
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DMITRY VAYNER
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Credential |
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Telephone | 929-666-0438
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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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