Provider Demographics
NPI:1437397353
Name:PACIFIC OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:PACIFIC OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WING
Authorized Official - Middle Name:KIN
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-219-8260
Mailing Address - Street 1:87 ELIZABETH ST
Mailing Address - Street 2:1ST FLOOR, STORE B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4992
Mailing Address - Country:US
Mailing Address - Phone:212-219-8260
Mailing Address - Fax:212-219-8283
Practice Address - Street 1:87 ELIZABETH ST
Practice Address - Street 2:1ST FLOOR, STORE B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4992
Practice Address - Country:US
Practice Address - Phone:212-219-8260
Practice Address - Fax:212-219-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000842Medicare PIN
NY5071010001Medicare NSC