Provider Demographics
NPI:1275660698
Name:EYELAND VISION OPTIQUE
Entity Type:Organization
Organization Name:EYELAND VISION OPTIQUE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LYUDMILA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBYNINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-420-6191
Mailing Address - Street 1:900 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2015
Mailing Address - Country:US
Mailing Address - Phone:718-420-6191
Mailing Address - Fax:718-420-6191
Practice Address - Street 1:900 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2015
Practice Address - Country:US
Practice Address - Phone:718-420-6191
Practice Address - Fax:718-420-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008251-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty