Provider Demographics
NPI:1326235227
Name:COLLEGE POINT OPTOMETRIC ASSOCIATES P.C.
Entity Type:Organization
Organization Name:COLLEGE POINT OPTOMETRIC ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANASTASIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:FOKAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-359-2834
Mailing Address - Street 1:1826 COLLEGE POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2221
Mailing Address - Country:US
Mailing Address - Phone:718-359-2834
Mailing Address - Fax:
Practice Address - Street 1:1826 COLLEGE POINT BLVD
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2221
Practice Address - Country:US
Practice Address - Phone:718-359-2834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV3614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
08310Medicare PIN
NY0399390001Medicare NSC