Provider Demographics
NPI:1093883746
Name:AVENUE D OPTICIANS INC
Entity Type:Organization
Organization Name:AVENUE D OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:N
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-629-9490
Mailing Address - Street 1:4403 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-5725
Mailing Address - Country:US
Mailing Address - Phone:718-629-9490
Mailing Address - Fax:718-451-0494
Practice Address - Street 1:4403 AVENUE D
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-5725
Practice Address - Country:US
Practice Address - Phone:718-629-9490
Practice Address - Fax:718-451-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0042251156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01715439Medicaid
NYC1W891Medicare ID - Type Unspecified
1055520001Medicare ID - Type Unspecified