Provider Demographics
NPI:1275637548
Name:25 WESTCHESTER SQUARE OPTICAL CORP
Entity Type:Organization
Organization Name:25 WESTCHESTER SQUARE OPTICAL CORP
Other - Org Name:METRO OPTICS EYEWEAR II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-597-6162
Mailing Address - Street 1:25 WESTCHESTER SQ
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3545
Mailing Address - Country:US
Mailing Address - Phone:718-597-6162
Mailing Address - Fax:718-597-6168
Practice Address - Street 1:25 WESTCHESTER SQ
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3545
Practice Address - Country:US
Practice Address - Phone:718-597-6162
Practice Address - Fax:718-597-6168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0522180001Medicare NSC
NYWWS071Medicare PIN