Provider Demographics
NPI:1558380196
Name:VENER, ALVIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:VENER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16432 CROSSBAY BLVD
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-3742
Mailing Address - Country:US
Mailing Address - Phone:718-322-5212
Mailing Address - Fax:718-322-5210
Practice Address - Street 1:16432 CROSSBAY BLVD
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-3742
Practice Address - Country:US
Practice Address - Phone:718-322-5212
Practice Address - Fax:718-322-5210
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT002489-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY57307AMedicare ID - Type UnspecifiedPROVIDER #