Provider Demographics
NPI:1750552501
Name:PARK SLOPE EYE, OPTOMETRIC PLLC
Entity type:Organization
Organization Name:PARK SLOPE EYE, OPTOMETRIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-863-9939
Mailing Address - Street 1:682 UNION ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1161
Mailing Address - Country:US
Mailing Address - Phone:212-863-9939
Mailing Address - Fax:888-850-6294
Practice Address - Street 1:682 UNION ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1161
Practice Address - Country:US
Practice Address - Phone:212-863-9939
Practice Address - Fax:888-850-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006867152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty