Provider Demographics
NPI:1871865220
Name:AEA VISION GROUP, INC
Entity Type:Organization
Organization Name:AEA VISION GROUP, INC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-792-8133
Mailing Address - Street 1:539 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-4302
Mailing Address - Country:US
Mailing Address - Phone:212-792-8133
Mailing Address - Fax:212-760-0105
Practice Address - Street 1:539 8TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4302
Practice Address - Country:US
Practice Address - Phone:212-792-8133
Practice Address - Fax:212-760-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004845332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier