=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912466707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMAICA EYE CARE CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2019
-----------------------------------------------------
Last Update Date | 03/19/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16820 JAMAICA AVE
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-5216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-739-5454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16820 JAMAICA AVE
-----------------------------------------------------
City | JAMAICA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11432-5216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-739-5454
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. BORIS KAPELNIK
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 847-404-3764
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------