Provider Demographics
NPI:1780043612
Name:CHANGE I WEAR INC
Entity Type:Organization
Organization Name:CHANGE I WEAR INC
Other - Org Name:CHANGE IWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PLISHTIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-708-9300
Mailing Address - Street 1:1755 CROSBY AVE
Mailing Address - Street 2:2J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4901
Mailing Address - Country:US
Mailing Address - Phone:917-708-9300
Mailing Address - Fax:347-398-5082
Practice Address - Street 1:1755 CROSBY AVE
Practice Address - Street 2:2J
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4901
Practice Address - Country:US
Practice Address - Phone:917-708-9300
Practice Address - Fax:347-398-5082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-20
Last Update Date:2016-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV007517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty