MEDICARE: THIRD AVENUE VISION EXPRESS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1497353486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THIRD AVENUE VISION EXPRESS LLC

Provider Business Mailing Address
First Line	:	2856 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-2726
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2856 3RD AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-2726
Country	:	US
Telephone Number	:	718-585-5100
Fax Number	:	718-292-0805

Authorized Official
Title or Position	:	OWNER
Name	:	LEONID VAYNER
Credential	:
Telephone Number	:	917-748-1570

Provider Enumeration Date	:	10/13/2020
Last Update Date	:	10/13/2020

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Directions to “THIRD AVENUE VISION EXPRESS LLC ” Practice Location

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