Provider Demographics
NPI:1437246279
Name:METROPOLITAN OPTOMETRIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:METROPOLITAN OPTOMETRIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:646-875-8828
Mailing Address - Street 1:595 W 239TH ST
Mailing Address - Street 2:APT B3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1291
Mailing Address - Country:US
Mailing Address - Phone:646-875-8828
Mailing Address - Fax:646-875-8828
Practice Address - Street 1:595 W 239TH ST
Practice Address - Street 2:APT B3
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1291
Practice Address - Country:US
Practice Address - Phone:646-875-8828
Practice Address - Fax:646-875-8828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2341237OtherAETNA PROVIDER