Provider Demographics
NPI:1245547694
Name:NORTH QUEENS OPTOMETRIC ASSOCIATES PLLC
Entity type:Organization
Organization Name:NORTH QUEENS OPTOMETRIC ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN-O'CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-426-5526
Mailing Address - Street 1:919 N BAY AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2545
Mailing Address - Country:US
Mailing Address - Phone:516-541-7861
Mailing Address - Fax:
Practice Address - Street 1:13505 20TH AVE
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2446
Practice Address - Country:US
Practice Address - Phone:718-661-0713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 006091152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty