Provider Demographics
NPI:1346583655
Name:WOODSIDE OPTICAL CORP.
Entity Type:Organization
Organization Name:WOODSIDE OPTICAL CORP.
Other - Org Name:NEW VIEW VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KULBERG
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:845-673-3613
Mailing Address - Street 1:6108 WOODSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-3543
Mailing Address - Country:US
Mailing Address - Phone:718-505-1700
Mailing Address - Fax:718-505-1414
Practice Address - Street 1:202 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-6733
Practice Address - Country:US
Practice Address - Phone:845-673-3613
Practice Address - Fax:718-505-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty