Provider Demographics
NPI:1942444914
Name:LENS EXPRESS OPTICAL, INC
Entity Type:Organization
Organization Name:LENS EXPRESS OPTICAL, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SVELTANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINOVA
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-261-2344
Mailing Address - Street 1:12430 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1501
Mailing Address - Country:US
Mailing Address - Phone:718-261-2344
Mailing Address - Fax:718-261-3356
Practice Address - Street 1:12430 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1501
Practice Address - Country:US
Practice Address - Phone:718-261-2344
Practice Address - Fax:718-261-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007438332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG100007317Medicare PIN