Provider Demographics
NPI:1568139582
Name:YOUR FAMILY EYECARE OPTOMETRY PC
Entity Type:Organization
Organization Name:YOUR FAMILY EYECARE OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:KHRYSTYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROZHYNSKA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:646-387-5783
Mailing Address - Street 1:89 ALAN LOOP
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-4434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:89 ALAN LOOP
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10304-4434
Practice Address - Country:US
Practice Address - Phone:646-387-5783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04905033Medicaid