Provider Demographics
NPI:1760633788
Name:LEEVISION OPHTHALMOLOGY SERVICES PLLC
Entity Type:Organization
Organization Name:LEEVISION OPHTHALMOLOGY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-461-5050
Mailing Address - Street 1:142-18 38TH AVE.
Mailing Address - Street 2:SUITE #1A
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-461-5050
Mailing Address - Fax:718-461-5656
Practice Address - Street 1:142-18 38TH AVE.
Practice Address - Street 2:SUITE #1A
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-461-5050
Practice Address - Fax:718-461-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205979207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01740789Medicaid
NY94T632OtherEMPIRE MEDICARE
NY94T632OtherEMPIRE MEDICARE
NYG46337Medicare UPIN