Provider Demographics
NPI:1235780719
Name:COCOS VISION DESIGNER OPTICAL
Entity Type:Organization
Organization Name:COCOS VISION DESIGNER OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARAONOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-727-5070
Mailing Address - Street 1:3185 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3908
Mailing Address - Country:US
Mailing Address - Phone:718-685-2009
Mailing Address - Fax:
Practice Address - Street 1:3185 STEINWAY ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-3908
Practice Address - Country:US
Practice Address - Phone:718-685-2009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COCOS VISION DESIGNER OPTICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty