Provider Demographics
NPI:1275533432
Name:FOKAS, ANASTASIOS (OD)
Entity Type:Individual
Prefix:
First Name:ANASTASIOS
Middle Name:
Last Name:FOKAS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2182 STEINWAY ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-1805
Mailing Address - Country:US
Mailing Address - Phone:718-626-3944
Mailing Address - Fax:718-626-4933
Practice Address - Street 1:2318 31ST ST
Practice Address - Street 2:SUITE # 220
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2892
Practice Address - Country:US
Practice Address - Phone:718-626-3944
Practice Address - Fax:718-626-4933
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2015-07-23
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
NYTUV005764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02114056Medicaid
NY5534730001OtherDURABLE GOODS
NY02114056Medicaid
NY5534730001OtherDURABLE GOODS