MEDICARE: BRONX VISTA INC

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	152W00000X	Optometrist	006388	NY

General Provider Information

NPI Number	:	1689044067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRONX VISTA INC

Provider Business Mailing Address
First Line	:	455 E 149TH STREET
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-1314
Country	:	US
Telephone Number	:	718-292-2020
Fax Number	:	718-585-1285

Provider Business Practice Location Address
First Line	:	457 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-1314
Country	:	US
Telephone Number	:	718-292-2020
Fax Number	:	718-585-1285

Authorized Official
Title or Position	:	OWNER
Name	:	MR. OLEG LISITSYN
Credential	:	OD
Telephone Number	:	718-292-2002

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	02/11/2026

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Directions to “BRONX VISTA INC ” Practice Location

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