Provider Demographics
NPI:1790538643
Name:4501 NYC OPTICAL LLC
Entity Type:Organization
Organization Name:4501 NYC OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MURATOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-934-6714
Mailing Address - Street 1:4501 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-1205
Mailing Address - Country:US
Mailing Address - Phone:718-879-8171
Mailing Address - Fax:
Practice Address - Street 1:811 SOUTHERN BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-5202
Practice Address - Country:US
Practice Address - Phone:718-924-2552
Practice Address - Fax:347-434-9876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-10
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty