Provider Demographics
NPI:1184207029
Name:IC OPTOMETRY PC
Entity Type:Organization
Organization Name:IC OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBRER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-769-9800
Mailing Address - Street 1:3364 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4004
Mailing Address - Country:US
Mailing Address - Phone:347-570-5348
Mailing Address - Fax:
Practice Address - Street 1:3364 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-4004
Practice Address - Country:US
Practice Address - Phone:347-570-5348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty