Provider Demographics
NPI:1376225995
Name:BAYSIDE VISION CORP
Entity Type:Organization
Organization Name:BAYSIDE VISION CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VLADIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:POLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-903-8161
Mailing Address - Street 1:4101 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2858
Mailing Address - Country:US
Mailing Address - Phone:718-428-6700
Mailing Address - Fax:
Practice Address - Street 1:4101 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2858
Practice Address - Country:US
Practice Address - Phone:718-428-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty