Provider Demographics
NPI:1073768529
Name:PRAISE EYE CARE, OD PLLC
Entity Type:Organization
Organization Name:PRAISE EYE CARE, OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IDY
Authorized Official - Middle Name:S
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-331-1491
Mailing Address - Street 1:1657 BATH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4509
Mailing Address - Country:US
Mailing Address - Phone:718-331-1491
Mailing Address - Fax:718-331-1491
Practice Address - Street 1:1657 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-4509
Practice Address - Country:US
Practice Address - Phone:718-331-1491
Practice Address - Fax:718-331-1491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006988152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000642OtherMEDICARE PTAN