Provider Demographics
NPI:1164649133
Name:WINDSOR PARK VISION CENTER, LTD
Entity Type:Organization
Organization Name:WINDSOR PARK VISION CENTER, LTD
Other - Org Name:WINDSOR PARK OPTICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNAO, ABO, NCLE
Authorized Official - Phone:718-225-5533
Mailing Address - Street 1:21411 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-2947
Mailing Address - Country:US
Mailing Address - Phone:718-225-5533
Mailing Address - Fax:718-225-5803
Practice Address - Street 1:21411 73RD AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2947
Practice Address - Country:US
Practice Address - Phone:718-225-5533
Practice Address - Fax:718-225-5803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC4579332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY268OtherDAVIS
NY0082844OtherGHI
NYC53161OtherBCBS
NY905621OtherBLOCK
NY01052946Medicaid
NY100186461501OtherUHC
NYP986837OtherOXFORD
NY110958OtherEYEMED
NYTUV004679OtherHIP
NYTUV004679OtherHIP
NYT49126Medicare ID - Type Unspecified