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General NPI Number Information
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NPI Number | 1265714323
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Entity Type | Organization
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Legal Business Name | EYE CARE OPTICAL OF NY INC
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/14/2011
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Provider Practice Location Address
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Address Line | 5731 MYRTLE AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4933
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Country | US
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Telephone | 347-601-8395
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Fax |
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Provider Business Mailing Address
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Address Line | 5731 MYRTLE AVE
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City | RIDGEWOOD
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State | NY
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Zip | 11385-4933
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Country | US
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Telephone | 347-601-8395
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. VLADIMIR NESTERENKO
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Credential |
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Telephone | 347-601-8395
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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 | T002406
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License Number State | NY
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