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
State | License ID | Taxonomies |
---|---|---|
NY | 008071-1 | 332H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332H00000X | Suppliers | Eyewear Supplier |