Provider Demographics
NPI:1114446796
Name:LONG ISLAND VISION OPTOMETRY PC
Entity Type:Organization
Organization Name:LONG ISLAND VISION OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:646-734-6367
Mailing Address - Street 1:187 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3741
Mailing Address - Country:US
Mailing Address - Phone:646-734-6367
Mailing Address - Fax:718-373-9805
Practice Address - Street 1:630 OLD COUNTRY RD UNIT 493A
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3505
Practice Address - Country:US
Practice Address - Phone:516-408-5330
Practice Address - Fax:516-877-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04358247Medicaid