Provider Demographics
NPI:1588840375
Name:ALLON VISION INC.
Entity Type:Organization
Organization Name:ALLON VISION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLON
Authorized Official - Middle Name:
Authorized Official - Last Name:NEJATHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-229-6780
Mailing Address - Street 1:24812 NORTHERN BLVD
Mailing Address - Street 2:1D
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11362-1206
Mailing Address - Country:US
Mailing Address - Phone:718-229-6780
Mailing Address - Fax:
Practice Address - Street 1:24812 NORTHERN BLVD
Practice Address - Street 2:1D
Practice Address - City:LITTLE NECK
Practice Address - State:NY
Practice Address - Zip Code:11362-1207
Practice Address - Country:US
Practice Address - Phone:718-229-6780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02641743Medicaid
NYU98621Medicare UPIN
NY02641743Medicaid
NY5572020001Medicare NSC