Provider Demographics
NPI:1548793763
Name:BAY RIDGE VISION EXPRESS, LLC
Entity Type:Organization
Organization Name:BAY RIDGE VISION EXPRESS, LLC
Other - Org Name:THE OPTICAL CENTER OF BAY RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-748-1570
Mailing Address - Street 1:8310 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4511
Mailing Address - Country:US
Mailing Address - Phone:718-680-2020
Mailing Address - Fax:718-680-5771
Practice Address - Street 1:8310 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4511
Practice Address - Country:US
Practice Address - Phone:718-680-2020
Practice Address - Fax:718-680-5771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005304332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier