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General NPI Number Information
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NPI Number | 1346315470
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Entity Type | Organization
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Legal Business Name | BRIGHT VISION OPTOMETRY, P.C.
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 10/27/2014
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Provider Practice Location Address
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Address Line | 490 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-8031
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Country | US
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Telephone | 917-449-0479
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Fax |
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Provider Business Mailing Address
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Address Line | 372 AVENUE U APT 3A
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City | BROOKLYN
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State | NY
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Zip | 11223-4052
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Country | US
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Telephone | 917-449-0479
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DMITRY GUREVICH
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Credential | O.D.
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Telephone | 917-449-0479
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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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