Provider Demographics
NPI:1972759827
Name:MICHELLE & OLIVIA ENTERPRISE
Entity Type:Organization
Organization Name:MICHELLE & OLIVIA ENTERPRISE
Other - Org Name:DABO EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-321-1212
Mailing Address - Street 1:4101 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3138
Mailing Address - Country:US
Mailing Address - Phone:718-321-1212
Mailing Address - Fax:718-321-3276
Practice Address - Street 1:4101 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3138
Practice Address - Country:US
Practice Address - Phone:718-321-1212
Practice Address - Fax:718-321-3276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02263514Medicaid