Provider Demographics
NPI:1447393814
Name:ANDRIELLE OPTICAL CORP
Entity Type:Organization
Organization Name:ANDRIELLE OPTICAL CORP
Other - Org Name:AMERICAN VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-793-1200
Mailing Address - Street 1:7051 AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4729
Mailing Address - Country:US
Mailing Address - Phone:718-793-1200
Mailing Address - Fax:791-793-2081
Practice Address - Street 1:7051 AUSTIN ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4729
Practice Address - Country:US
Practice Address - Phone:718-793-1200
Practice Address - Fax:791-793-2081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4173156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY116817OtherEYEMED
NY1001100000OtherUFT
NY0637010001Medicare ID - Type UnspecifiedPROVIDER NUMBER