Provider Demographics
NPI:1710540471
Name:FAMILY OPTOMETRY 121 PC
Entity Type:Organization
Organization Name:FAMILY OPTOMETRY 121 PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-618-7855
Mailing Address - Street 1:3300 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-6748
Mailing Address - Country:US
Mailing Address - Phone:718-618-7855
Mailing Address - Fax:718-618-7957
Practice Address - Street 1:3300 THIRD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-6748
Practice Address - Country:US
Practice Address - Phone:718-618-7855
Practice Address - Fax:718-618-7957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty