Provider Demographics
NPI:1164703054
Name:VALLEY STREAM OPTOMERTY & OPTICIAN PLLC
Entity Type:Organization
Organization Name:VALLEY STREAM OPTOMERTY & OPTICIAN PLLC
Other - Org Name:HOWARD EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VLAD
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-561-8545
Mailing Address - Street 1:129 ROCKAWAY AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-5812
Mailing Address - Country:US
Mailing Address - Phone:516-561-8545
Mailing Address - Fax:
Practice Address - Street 1:129 ROCKAWAY AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-5812
Practice Address - Country:US
Practice Address - Phone:516-561-8545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006396152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty