Provider Demographics
NPI:1083060131
Name:VALLEY STREAM OPTOMETRIC SERVICES PC
Entity Type:Organization
Organization Name:VALLEY STREAM OPTOMETRIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WIANECKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-825-7455
Mailing Address - Street 1:5 SUNRISE PLZ STE 101
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-6130
Mailing Address - Country:US
Mailing Address - Phone:516-825-7455
Mailing Address - Fax:516-825-1494
Practice Address - Street 1:5 SUNRISE PLZ STE 101
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-6130
Practice Address - Country:US
Practice Address - Phone:516-825-7455
Practice Address - Fax:516-825-1494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-09
Last Update Date:2024-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0065341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty