Provider Demographics
NPI:1336206127
Name:EURO-OPTICA EYEWEAR, INC.
Entity Type:Organization
Organization Name:EURO-OPTICA EYEWEAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF OPTOMETRY
Authorized Official - Phone:718-520-6500
Mailing Address - Street 1:6405 YELLOWSTONE BLVD
Mailing Address - Street 2:SUITE CF-103
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1530
Mailing Address - Country:US
Mailing Address - Phone:718-520-6500
Mailing Address - Fax:718-520-6595
Practice Address - Street 1:6405 YELLOWSTONE BLVD
Practice Address - Street 2:SUITE CF-103
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1530
Practice Address - Country:US
Practice Address - Phone:718-520-6500
Practice Address - Fax:718-520-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05527Medicare PIN
NY5116310001Medicare NSC