Provider Demographics
NPI:1952641821
Name:BRONX VISION CENTER INC.
Entity Type:Organization
Organization Name:BRONX VISION CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-891-8555
Mailing Address - Street 1:417 E 138TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-3004
Mailing Address - Country:US
Mailing Address - Phone:917-642-1035
Mailing Address - Fax:
Practice Address - Street 1:417 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3004
Practice Address - Country:US
Practice Address - Phone:917-642-1035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-28
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100088540Medicare PIN