Provider Demographics
NPI:1851794440
Name:STARGAZE EYE CARE OPTOMETRY P.C.
Entity Type:Organization
Organization Name:STARGAZE EYE CARE OPTOMETRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:MIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-621-9283
Mailing Address - Street 1:13620 MAPLE AVE # C701
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5166
Mailing Address - Country:US
Mailing Address - Phone:917-621-9283
Mailing Address - Fax:347-510-0088
Practice Address - Street 1:13620 MAPLE AVE # C701
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5166
Practice Address - Country:US
Practice Address - Phone:917-621-9283
Practice Address - Fax:347-510-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-26
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007560152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03292404Medicaid