Provider Demographics
NPI:1659924397
Name:QUEENS VISTASITE EYECARE INC.
Entity Type:Organization
Organization Name:QUEENS VISTASITE EYECARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:LISITSYN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:929-487-0808
Mailing Address - Street 1:9119 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5531
Mailing Address - Country:US
Mailing Address - Phone:929-487-0808
Mailing Address - Fax:929-487-0809
Practice Address - Street 1:9119 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5531
Practice Address - Country:US
Practice Address - Phone:929-487-0808
Practice Address - Fax:929-487-0809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty