Provider Demographics
NPI:1205908555
Name:VIZEL, AVRAHAM C (OPTICIAN)
Entity type:Individual
Prefix:
First Name:AVRAHAM
Middle Name:C
Last Name:VIZEL
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2922 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4639
Mailing Address - Country:US
Mailing Address - Phone:718-758-2020
Mailing Address - Fax:
Practice Address - Street 1:2922 AVENUE L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-4639
Practice Address - Country:US
Practice Address - Phone:718-758-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC-007816156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098539Medicaid
NY02098557Medicaid