Provider Demographics
NPI:1740385194
Name:VEYANA OPTICAL
Entity Type:Organization
Organization Name:VEYANA OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTLYAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-421-7209
Mailing Address - Street 1:6 NEWKIRK PLAZA
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-6526
Mailing Address - Country:US
Mailing Address - Phone:718-421-7209
Mailing Address - Fax:718-421-7209
Practice Address - Street 1:6 NEWKIRK PLAZA
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-6526
Practice Address - Country:US
Practice Address - Phone:718-421-7209
Practice Address - Fax:718-421-7209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007361-01156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01517844Medicaid