Provider Demographics
NPI:1417499641
Name:OPTICAL CARE LLC
Entity Type:Organization
Organization Name:OPTICAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YONATAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-626-9400
Mailing Address - Street 1:3117 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2488
Mailing Address - Country:US
Mailing Address - Phone:718-626-9400
Mailing Address - Fax:
Practice Address - Street 1:3117 23RD AVE
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2488
Practice Address - Country:US
Practice Address - Phone:718-626-9400
Practice Address - Fax:718-626-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT-003856-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty