Provider Demographics
NPI:1235431750
Name:CITI CENTER OPTICAL INC
Entity Type:Organization
Organization Name:CITI CENTER OPTICAL INC
Other - Org Name:PITKIN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YACOUBA
Authorized Official - Middle Name:
Authorized Official - Last Name:KONATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-495-2065
Mailing Address - Street 1:1182 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7005
Mailing Address - Country:US
Mailing Address - Phone:718-495-2065
Mailing Address - Fax:718-495-2006
Practice Address - Street 1:1182 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7005
Practice Address - Country:US
Practice Address - Phone:718-495-2065
Practice Address - Fax:718-495-2006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100048356Medicare PIN