Provider Demographics
NPI:1174830988
Name:SUNNYSIDE OPTOMETRY P.C.
Entity Type:Organization
Organization Name:SUNNYSIDE OPTOMETRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VARUJAN
Authorized Official - Last Name:KALUSTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-801-6323
Mailing Address - Street 1:7 SINCLAIR MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1184
Mailing Address - Country:US
Mailing Address - Phone:516-801-6323
Mailing Address - Fax:888-314-7302
Practice Address - Street 1:4701 QUEENS BLVD
Practice Address - Street 2:SUITE NUMBER 303
Practice Address - City:SUNNYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11104-1600
Practice Address - Country:US
Practice Address - Phone:516-801-6323
Practice Address - Fax:888-314-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006238152W00000X, 152WC0802X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty