Provider Demographics
NPI:1376941583
Name:GREENPOINT EYE CARE LLC
Entity Type:Organization
Organization Name:GREENPOINT EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KISELOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-389-0333
Mailing Address - Street 1:909 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5960
Mailing Address - Country:US
Mailing Address - Phone:718-389-0333
Mailing Address - Fax:718-389-0400
Practice Address - Street 1:909 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5960
Practice Address - Country:US
Practice Address - Phone:718-389-0333
Practice Address - Fax:718-389-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006648-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02896642Medicaid
NY02896642Medicaid