Provider Demographics
NPI:1184392490
Name:OLEXIO, IAN PRICE (OD)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:PRICE
Last Name:OLEXIO
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 1:261 EVERGREEN AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-6260
Mailing Address - Country:US
Mailing Address - Phone:614-499-3223
Mailing Address - Fax:
Practice Address - Street 1:16415 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4913
Practice Address - Country:US
Practice Address - Phone:929-218-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009457152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty