Provider Demographics
NPI:1659429850
Name:EYES ON ISLAND INC.
Entity Type:Organization
Organization Name:EYES ON ISLAND INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAIKHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-948-1353
Mailing Address - Street 1:150 GREAVES LN
Mailing Address - Street 2:D
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2173
Mailing Address - Country:US
Mailing Address - Phone:718-948-1353
Mailing Address - Fax:718-948-1353
Practice Address - Street 1:150 GREAVES LN
Practice Address - Street 2:D
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2173
Practice Address - Country:US
Practice Address - Phone:718-948-1353
Practice Address - Fax:718-948-1353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-07
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7918156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02354763Medicaid
NYWFE601Medicare PIN