Provider Demographics
NPI:1770115636
Name:BROOKLYN EYE CARE LLC
Entity type:Organization
Organization Name:BROOKLYN EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:EKEMEZIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:763-843-7153
Mailing Address - Street 1:12828 FLANDERS ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6289
Mailing Address - Country:US
Mailing Address - Phone:763-843-7153
Mailing Address - Fax:
Practice Address - Street 1:9670 COLORADO LN N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2385
Practice Address - Country:US
Practice Address - Phone:763-843-7153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty