Provider Demographics
NPI:1275587610
Name:WOODHAVEN OPTICAL CENTER
Entity Type:Organization
Organization Name:WOODHAVEN OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEITER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-847-1946
Mailing Address - Street 1:8921 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2041
Mailing Address - Country:US
Mailing Address - Phone:718-847-1946
Mailing Address - Fax:718-849-7326
Practice Address - Street 1:8921 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2041
Practice Address - Country:US
Practice Address - Phone:718-847-1946
Practice Address - Fax:718-849-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004302152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1001850000OtherUFT
NYOP1079OtherEYEMED
NY50580OtherDAVIS VISION
NY713OtherVISION SCREENING
NY02375340Medicaid
NY09282OtherSPECTERA
NY1300620001OtherMEDICARE (CMS)
NY333552OtherNVA
NY50580OtherDAVIS VISION
NY05614Medicare ID - Type UnspecifiedMEDICARE (GHI)
NY02375340Medicaid