Provider Demographics
NPI:1932285939
Name:LAXMI AMERICAN OPTICAL
Entity Type:Organization
Organization Name:LAXMI AMERICAN OPTICAL
Other - Org Name:LAXMI AMERICAN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:VIKAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:OPHTHALMIC DISPENSER
Authorized Official - Phone:718-335-2240
Mailing Address - Street 1:83 16 NOTHERN BLVD
Mailing Address - Street 2:LAXMI AMERICAN OPTICL
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372
Mailing Address - Country:US
Mailing Address - Phone:718-335-2240
Mailing Address - Fax:718-335-2241
Practice Address - Street 1:83 16 NOTHERN BLVD
Practice Address - Street 2:LAXMI AMERICAN OPTICAL
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-335-2240
Practice Address - Fax:718-335-2241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007786 1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02744076Medicaid