Provider Demographics
NPI:1295328979
Name:AJ KEW GARDEN OPTICAL CORP
Entity type:Organization
Organization Name:AJ KEW GARDEN OPTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-877-9606
Mailing Address - Street 1:7259 KISSENA BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2165
Mailing Address - Country:US
Mailing Address - Phone:718-263-2020
Mailing Address - Fax:718-263-2028
Practice Address - Street 1:7259 KISSENA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2165
Practice Address - Country:US
Practice Address - Phone:718-263-2020
Practice Address - Fax:718-263-2028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty