Provider Demographics
NPI:1376800482
Name:EYELAND VISIONCARE INC
Entity Type:Organization
Organization Name:EYELAND VISIONCARE INC
Other - Org Name:FLUSHING EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:QIANG
Authorized Official - Last Name:YIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-886-8858
Mailing Address - Street 1:4034 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6044
Mailing Address - Country:US
Mailing Address - Phone:718-886-8858
Mailing Address - Fax:718-886-8897
Practice Address - Street 1:4034 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6044
Practice Address - Country:US
Practice Address - Phone:718-886-8858
Practice Address - Fax:718-886-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02680871Medicaid