Provider Demographics
NPI:1780750141
Name:WOODHAVEN OPTOMETRIC ASSOCIATES, P.C.
Entity type:Organization
Organization Name:WOODHAVEN OPTOMETRIC ASSOCIATES, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRA
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-847-8877
Mailing Address - Street 1:9301 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2220
Mailing Address - Country:US
Mailing Address - Phone:718-847-8877
Mailing Address - Fax:718-849-5934
Practice Address - Street 1:9301 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2220
Practice Address - Country:US
Practice Address - Phone:718-847-8877
Practice Address - Fax:718-849-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004811332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01526636Medicaid
NY0217460002Medicare ID - Type Unspecified