Provider Demographics
NPI:1669526877
Name:MISYUK, ALEKSANDR (OPTICIAN)
Entity type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:MISYUK
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 SHELL RD
Mailing Address - Street 2:#9-0
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-3634
Mailing Address - Country:US
Mailing Address - Phone:917-750-0880
Mailing Address - Fax:
Practice Address - Street 1:88 FULTON ST
Practice Address - Street 2:MY OPTICIAN NYC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-2807
Practice Address - Country:US
Practice Address - Phone:212-693-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007265156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician