Provider Demographics
NPI:1659094837
Name:BAYSIDE FAMILY EYECARE INC
Entity Type:Organization
Organization Name:BAYSIDE FAMILY EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRASLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYZAKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-556-0903
Mailing Address - Street 1:20836 CROSS ISLAND PKWY
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1187
Mailing Address - Country:US
Mailing Address - Phone:718-224-1833
Mailing Address - Fax:718-224-1877
Practice Address - Street 1:20836 CROSS ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-1187
Practice Address - Country:US
Practice Address - Phone:718-224-1833
Practice Address - Fax:718-224-1877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty