Provider Demographics
NPI:1003461880
Name:GOYAL, VIVEK (OD)
Entity type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:GOYAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 SEARINGTOWN RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1157
Mailing Address - Country:US
Mailing Address - Phone:516-998-8095
Mailing Address - Fax:
Practice Address - Street 1:16501 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4904
Practice Address - Country:US
Practice Address - Phone:718-523-0730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3110152W00000X
NY009133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist