Provider Demographics
NPI:1134188667
Name:V&R OPTOMETRIC ASSOCIATES
Entity type:Organization
Organization Name:V&R OPTOMETRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSTISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:RYVKIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-513-4052
Mailing Address - Street 1:105 KINGS HWY
Mailing Address - Street 2:APT#3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1525
Mailing Address - Country:US
Mailing Address - Phone:718-513-4052
Mailing Address - Fax:
Practice Address - Street 1:105 KINGS HWY
Practice Address - Street 2:APT#3A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-1525
Practice Address - Country:US
Practice Address - Phone:718-513-4052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006615152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty