Provider Demographics
NPI:1689044067
Name:BRONX VISTA INC
Entity Type:Organization
Organization Name:BRONX VISTA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:LISITSYN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-292-2002
Mailing Address - Street 1:455 E 149TH STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-1314
Mailing Address - Country:US
Mailing Address - Phone:718-292-2020
Mailing Address - Fax:718-585-1285
Practice Address - Street 1:455 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-1314
Practice Address - Country:US
Practice Address - Phone:718-292-2020
Practice Address - Fax:718-585-1285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty