Provider Demographics
NPI:1528232030
Name:LEXINGTON OPTICAL EXPRESS
Entity Type:Organization
Organization Name:LEXINGTON OPTICAL EXPRESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-360-7422
Mailing Address - Street 1:2058B LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10035-1732
Mailing Address - Country:US
Mailing Address - Phone:212-360-7422
Mailing Address - Fax:212-360-1969
Practice Address - Street 1:2058B LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10035-1732
Practice Address - Country:US
Practice Address - Phone:212-360-7422
Practice Address - Fax:212-360-1969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005611-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01539284Medicaid