Provider Demographics
NPI:1760897235
Name:HAN, CRYSTAL (OD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 FANWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3101
Mailing Address - Country:US
Mailing Address - Phone:516-728-0712
Mailing Address - Fax:
Practice Address - Street 1:3925 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2060
Practice Address - Country:US
Practice Address - Phone:718-279-2020
Practice Address - Fax:718-279-3702
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-24
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002932152W00000X
NJ270A00668500152W00000X
NYTUV008121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist