Provider Demographics
NPI:1508827890
Name:QUEENS OPTOMETRIC ASSOCIATES PC
Entity Type:Organization
Organization Name:QUEENS OPTOMETRIC ASSOCIATES PC
Other - Org Name:QUEENS EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ARAKADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELENOW
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-463-3412
Mailing Address - Street 1:29 03 UNION STREET
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2202
Mailing Address - Country:US
Mailing Address - Phone:718-463-3412
Mailing Address - Fax:718-445-0867
Practice Address - Street 1:29 03 UNION STREET
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2202
Practice Address - Country:US
Practice Address - Phone:718-463-3412
Practice Address - Fax:718-445-0867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01210Medicare PIN