Provider Demographics
NPI:1013523000
Name:FORDHAM VISION CENTER NY LLC
Entity Type:Organization
Organization Name:FORDHAM VISION CENTER NY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPELNIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:847-404-3764
Mailing Address - Street 1:1 E FORDHAM RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-5400
Mailing Address - Country:US
Mailing Address - Phone:718-733-6700
Mailing Address - Fax:
Practice Address - Street 1:1 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-5400
Practice Address - Country:US
Practice Address - Phone:718-733-6700
Practice Address - Fax:718-733-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty