Provider Demographics
NPI:1225087471
Name:BAYVIEW OPTICAL
Entity Type:Organization
Organization Name:BAYVIEW OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LILIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PILIPENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-449-7164
Mailing Address - Street 1:2020 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-3204
Mailing Address - Country:US
Mailing Address - Phone:718-449-7164
Mailing Address - Fax:
Practice Address - Street 1:2020 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-3204
Practice Address - Country:US
Practice Address - Phone:718-449-7164
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-07
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007565152W00000X
NY006939-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01676851Medicaid
NYC5W651Medicare ID - Type Unspecified
1228190001Medicare NSC