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General NPI Number Information
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NPI Number | 1881086015
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Entity Type | Organization
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Legal Business Name | EYE LAB OPTICIAN PC
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Dates
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Enumeration Date | 02/25/2015
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 8113 LEFFERTS BLVD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1727
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Country | US
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Telephone | 718-849-0847
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Fax | 718-849-0864
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Provider Business Mailing Address
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Address Line | 8113 LEFFERTS BLVD
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City | KEW GARDENS
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State | NY
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Zip | 11415-1727
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Country | US
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Telephone | 718-849-0847
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Fax | 718-849-0864
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Authorized Official
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Title or Position | OWNER
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Name | BAHUR YACOBOV
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Credential | OPTICIAN
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Telephone | 718-849-0847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 6538-1
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License Number State | NY
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