Provider Demographics
NPI:1497165468
Name:OPTIMEYES VISION OF LIC OPTOMETRIC ASSOCIATES PLLC
Entity Type:Organization
Organization Name:OPTIMEYES VISION OF LIC OPTOMETRIC ASSOCIATES PLLC
Other - Org Name:OPTIMEYES VISION OF LIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-482-8882
Mailing Address - Street 1:527 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-5711
Mailing Address - Country:US
Mailing Address - Phone:718-482-8882
Mailing Address - Fax:718-482-9880
Practice Address - Street 1:527 50TH AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-5711
Practice Address - Country:US
Practice Address - Phone:718-482-8882
Practice Address - Fax:718-482-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006968152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty