Provider Demographics
NPI:1477703577
Name:KEW GARDENS OPTOMETRY, P.C.
Entity Type:Organization
Organization Name:KEW GARDENS OPTOMETRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEZHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOURIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-263-2020
Mailing Address - Street 1:10304 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2330
Mailing Address - Country:US
Mailing Address - Phone:718-424-1333
Mailing Address - Fax:718-424-1330
Practice Address - Street 1:10304 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2330
Practice Address - Country:US
Practice Address - Phone:718-424-1333
Practice Address - Fax:718-424-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03287845Medicaid
NY6258170002Medicare NSC
NY03287845Medicaid