Provider Demographics
NPI:1356085393
Name:LENS LAB OPTICAL 181 INC
Entity Type:Organization
Organization Name:LENS LAB OPTICAL 181 INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-795-5640
Mailing Address - Street 1:4250 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3748
Mailing Address - Country:US
Mailing Address - Phone:212-795-5640
Mailing Address - Fax:212-927-6210
Practice Address - Street 1:4250 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3748
Practice Address - Country:US
Practice Address - Phone:212-795-5640
Practice Address - Fax:212-927-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty