Provider Demographics
NPI:1609064153
Name:QUEENS OPTOMETRIC CARE PLLC
Entity Type:Organization
Organization Name:QUEENS OPTOMETRIC CARE PLLC
Other - Org Name:BRONX EYE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-547-2020
Mailing Address - Street 1:665 PELHAM PKWY N
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-8068
Mailing Address - Country:US
Mailing Address - Phone:718-547-2020
Mailing Address - Fax:718-547-3021
Practice Address - Street 1:665 PELHAM PKWY N
Practice Address - Street 2:SUITE 202
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-8069
Practice Address - Country:US
Practice Address - Phone:718-547-2020
Practice Address - Fax:718-547-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03287547Medicaid
NYA100019255Medicare PIN
NY03287547Medicaid
NY4124670002Medicare NSC