Provider Demographics
NPI:1407852684
Name:ESTREN, HARVEY I (OD)
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:I
Last Name:ESTREN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 520
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-0520
Mailing Address - Country:US
Mailing Address - Phone:631-226-2313
Mailing Address - Fax:631-226-3169
Practice Address - Street 1:164 N WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-4006
Practice Address - Country:US
Practice Address - Phone:631-226-2313
Practice Address - Fax:631-226-3169
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT 3256-1 NY152WC0802X, 152WL0500X, 152WP0200X
NYVUT-3256-1 NY152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC33321Medicare PIN
NYU09760Medicare UPIN