Provider Demographics
NPI:1568643161
Name:VICTORY VISION CARE INC.
Entity Type:Organization
Organization Name:VICTORY VISION CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYUBOMYRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLESNYK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-622-2020
Mailing Address - Street 1:565 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1913
Mailing Address - Country:US
Mailing Address - Phone:718-622-2020
Mailing Address - Fax:718-622-5404
Practice Address - Street 1:565 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1913
Practice Address - Country:US
Practice Address - Phone:718-622-2020
Practice Address - Fax:718-622-5404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-25
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006618-1152W00000X, 152WC0802X, 152WL0500X, 152WX0102X
NY008716156FX1800X
NY008716-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02857014Medicaid
NY02967568Medicaid
NY02970267Medicaid
NY02970267Medicaid
NY02967568Medicaid
NYU96957Medicare UPIN