Provider Demographics
NPI:1356460968
Name:OPTOMETRIC EYE SERVICES LLC
Entity Type:Organization
Organization Name:OPTOMETRIC EYE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZUPA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:201-694-7701
Mailing Address - Street 1:637 WYCKOFF AVE.
Mailing Address - Street 2:STE 233
Mailing Address - City:WYCKOFF
Mailing Address - State:NJ
Mailing Address - Zip Code:07481
Mailing Address - Country:US
Mailing Address - Phone:201-694-7701
Mailing Address - Fax:
Practice Address - Street 1:10 SHERIDAN SQ
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-6867
Practice Address - Country:US
Practice Address - Phone:212-242-6592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY5512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty