Provider Demographics
NPI:1407940638
Name:AGAPE VISION INC
Entity Type:Organization
Organization Name:AGAPE VISION INC
Other - Org Name:AGAPE VISION II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:L
Authorized Official - Last Name:RISKO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-712-2020
Mailing Address - Street 1:206 13 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428
Mailing Address - Country:US
Mailing Address - Phone:718-712-2020
Mailing Address - Fax:718-740-7041
Practice Address - Street 1:206 13 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428
Practice Address - Country:US
Practice Address - Phone:718-712-2020
Practice Address - Fax:718-740-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty