Provider Demographics
NPI:1568989960
Name:86TH ST. VISION EXPRESS, LLC
Entity Type:Organization
Organization Name:86TH ST. VISION EXPRESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-748-1570
Mailing Address - Street 1:414 86TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4708
Mailing Address - Country:US
Mailing Address - Phone:718-833-2320
Mailing Address - Fax:718-833-1194
Practice Address - Street 1:414 86TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4708
Practice Address - Country:US
Practice Address - Phone:718-833-2320
Practice Address - Fax:718-833-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty