Provider Demographics
NPI:1568648574
Name:OPTI-KING,LLC.
Entity Type:Organization
Organization Name:OPTI-KING,LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:XIMENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-926-1912
Mailing Address - Street 1:101 SHERMAN AVE
Mailing Address - Street 2:#8
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-5626
Mailing Address - Country:US
Mailing Address - Phone:212-569-2020
Mailing Address - Fax:212-569-2021
Practice Address - Street 1:101 SHERMAN AVE
Practice Address - Street 2:#8
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-5626
Practice Address - Country:US
Practice Address - Phone:212-569-2020
Practice Address - Fax:212-569-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006758152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty