Provider Demographics
NPI:1619226784
Name:HALL OF FRAMES OPTHALMIC DISPENSING PC
Entity Type:Organization
Organization Name:HALL OF FRAMES OPTHALMIC DISPENSING PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALEKSANDR
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMUNOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-204-6655
Mailing Address - Street 1:16712 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-3250
Mailing Address - Country:US
Mailing Address - Phone:917-204-6655
Mailing Address - Fax:
Practice Address - Street 1:1550 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-1503
Practice Address - Country:US
Practice Address - Phone:917-819-3239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007474156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty