Provider Demographics
NPI:1881853927
Name:OCEAN VIEW OPTICAL OF BROOKLYN, INC.
Entity Type:Organization
Organization Name:OCEAN VIEW OPTICAL OF BROOKLYN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:GORODISHCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-769-9800
Mailing Address - Street 1:254 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-7427
Mailing Address - Country:US
Mailing Address - Phone:718-769-9800
Mailing Address - Fax:
Practice Address - Street 1:254 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7427
Practice Address - Country:US
Practice Address - Phone:718-769-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01471865Medicaid
NYCAWJP1Medicare PIN
NY01471865Medicaid