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General NPI Number Information
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NPI Number | 1174014591
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Entity Type | Organization
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Legal Business Name | NY OPTOMETRIST VISION PC
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 15036 UNION TPKE
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City | FLUSHING
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State | NY
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Zip | 11367-3928
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Country | US
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Telephone | 718-591-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 15036 UNION TPKE
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City | FLUSHING
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State | NY
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Zip | 11367-3928
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Country | US
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Telephone | 718-591-3000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEONARD FUZAYLOV
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Credential | O.D.
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Telephone | 718-591-3000
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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 | TUV008487
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License Number State | NY
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