Provider Demographics
NPI:1295786283
Name:VNV OPTICAL INTERNATIONAL, CORP
Entity type:Organization
Organization Name:VNV OPTICAL INTERNATIONAL, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMERIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-361-2351
Mailing Address - Street 1:43 E 167TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8206
Mailing Address - Country:US
Mailing Address - Phone:718-992-2128
Mailing Address - Fax:718-588-2045
Practice Address - Street 1:43 E 167TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8206
Practice Address - Country:US
Practice Address - Phone:718-992-2128
Practice Address - Fax:718-588-2045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005878152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02265007Medicaid
U72287Medicare UPIN