Provider Demographics
NPI:1497782080
Name:VASSERMAN, TSYLYA U (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:TSYLYA
Middle Name:U
Last Name:VASSERMAN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VISION WORLD
Mailing Address - Street 2:91-12A ATLANTIC AVENUE
Mailing Address - City:OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11416-1527
Mailing Address - Country:US
Mailing Address - Phone:718-845-3737
Mailing Address - Fax:718-641-8461
Practice Address - Street 1:VISION WORLD 91-12A ATLANTIC AVENUE
Practice Address - Street 2:91-12A ATLANTIC AVENUE
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11416-1527
Practice Address - Country:US
Practice Address - Phone:718-845-3737
Practice Address - Fax:718-641-8461
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6952156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01923826Medicaid