Provider Demographics
NPI:1568987972
Name:5TH AVENUE VISION CENTER LLC
Entity Type:Organization
Organization Name:5TH AVENUE VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPELNIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:929-666-0438
Mailing Address - Street 1:5818 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3820
Mailing Address - Country:US
Mailing Address - Phone:718-439-8440
Mailing Address - Fax:718-439-7063
Practice Address - Street 1:5818 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220
Practice Address - Country:US
Practice Address - Phone:718-439-8440
Practice Address - Fax:718-439-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0071381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty