=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649418344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EYES & OPTICS LINCOLN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2009
-----------------------------------------------------
Last Update Date | 04/12/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 234 E 149TH ST ROOM 2-A3
-----------------------------------------------------
City | BRONX
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10451-5504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-665-0611
-----------------------------------------------------
Fax | 718-665-3546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2922 AVENUE L
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11210-4639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-513-6911
-----------------------------------------------------
Fax | 718-513-6912
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES
-----------------------------------------------------
Name | AVRAHAM VIZEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-513-6911
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | C-007816
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------