Provider Demographics
NPI:1679933642
Name:CENTRAL BROOKLYN VISION SERVICES
Entity Type:Organization
Organization Name:CENTRAL BROOKLYN VISION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:PIERRE
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:917-495-0357
Mailing Address - Street 1:529 NOSTRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-2879
Mailing Address - Country:US
Mailing Address - Phone:718-638-1844
Mailing Address - Fax:866-910-7380
Practice Address - Street 1:529 NOSTRAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-2879
Practice Address - Country:US
Practice Address - Phone:718-638-1844
Practice Address - Fax:866-910-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003831-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty