Provider Demographics
NPI:1760734297
Name:KINGS HIGHWAY VISION EXPRESS, LLC
Entity Type:Organization
Organization Name:KINGS HIGHWAY VISION EXPRESS, LLC
Other - Org Name:KINGS HIGHWAY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-627-8900
Mailing Address - Street 1:1302 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1970
Mailing Address - Country:US
Mailing Address - Phone:718-627-8900
Mailing Address - Fax:718-645-8017
Practice Address - Street 1:1302 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1970
Practice Address - Country:US
Practice Address - Phone:718-627-8900
Practice Address - Fax:718-645-8017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008071-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier