Provider Demographics
NPI:1467836551
Name:FAMILY EYE CENTER INC
Entity Type:Organization
Organization Name:FAMILY EYE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISHPATOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-755-0656
Mailing Address - Street 1:6923 168TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3213
Mailing Address - Country:US
Mailing Address - Phone:718-755-0656
Mailing Address - Fax:888-500-0406
Practice Address - Street 1:97-32 63 RD ROAD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-755-0656
Practice Address - Fax:888-500-0406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY EYE SENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007654-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08203Medicare PIN