Provider Demographics
NPI:1356544266
Name:ASTORIA VISION CENTER INC
Entity type:Organization
Organization Name:ASTORIA VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAIAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-204-2007
Mailing Address - Street 1:36-20 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1046
Mailing Address - Country:US
Mailing Address - Phone:718-204-2007
Mailing Address - Fax:718-204-2008
Practice Address - Street 1:3620 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1046
Practice Address - Country:US
Practice Address - Phone:718-204-2007
Practice Address - Fax:718-204-2008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006945-1156FX1800X
NYT004992-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty