Provider Demographics
NPI:1669456711
Name:RAYMOND FONG MD, PC
Entity Type:Organization
Organization Name:RAYMOND FONG MD, PC
Other - Org Name:NEW YORK EYE CENTER OPTICAL DISPENSARY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-274-1900
Mailing Address - Street 1:13620 38TH AVE
Mailing Address - Street 2:SUITE 6H
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4277
Mailing Address - Country:US
Mailing Address - Phone:718-762-3790
Mailing Address - Fax:718-762-0138
Practice Address - Street 1:109 LAFAYETTE ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4154
Practice Address - Country:US
Practice Address - Phone:212-274-1900
Practice Address - Fax:212-274-0738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-02
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150422332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0970130001Medicare NSC
NYC09931Medicare UPIN