Provider Demographics
NPI:1053494179
Name:EYEGLASS LIQUIDATORS INC.
Entity Type:Organization
Organization Name:EYEGLASS LIQUIDATORS INC.
Other - Org Name:MIRAGE OPTICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEBOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-849-0847
Mailing Address - Street 1:8113 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1727
Mailing Address - Country:US
Mailing Address - Phone:718-849-0847
Mailing Address - Fax:718-849-0864
Practice Address - Street 1:8113 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1727
Practice Address - Country:US
Practice Address - Phone:718-849-0847
Practice Address - Fax:718-849-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004326-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01764378Medicaid