Provider Demographics
NPI:1760814354
Name:ES EN EL EYE OPTOMETRISTS, PLLC
Entity Type:Organization
Organization Name:ES EN EL EYE OPTOMETRISTS, PLLC
Other - Org Name:REVOLUTION EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-608-1111
Mailing Address - Street 1:82 W. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007
Mailing Address - Country:US
Mailing Address - Phone:212-608-1111
Mailing Address - Fax:
Practice Address - Street 1:82 W BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1020
Practice Address - Country:US
Practice Address - Phone:212-608-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006862152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty