Provider Demographics
NPI:1902044829
Name:COSMOS TOTAL OPTOMETRY CARE PLLC
Entity Type:Organization
Organization Name:COSMOS TOTAL OPTOMETRY CARE PLLC
Other - Org Name:COSMOS EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OD, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:ECONOPOULY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-458-8500
Mailing Address - Street 1:90-01 ROOSEVELT AVENUE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:90-01 ROOSEVELT AVENUE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-458-8500
Practice Address - Fax:718-424-3366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-30
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006061VUT152W00000X
NYVUT006061332B00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02220473Medicaid
NY03628Medicare PIN
NYU76301Medicare UPIN
NY1269070001Medicare NSC