Provider Demographics
NPI:1609991645
Name:ECONOPOULY, JOANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:ECONOPOULY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9001 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7938
Mailing Address - Country:US
Mailing Address - Phone:718-458-8500
Mailing Address - Fax:718-424-3366
Practice Address - Street 1:9001 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7938
Practice Address - Country:US
Practice Address - Phone:718-458-9761
Practice Address - Fax:718-424-3366
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT006061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03628Medicare PIN
NYU76301Medicare UPIN
NY1269070001Medicare NSC