Provider Demographics
NPI:1780939546
Name:KINGS PLAZA OPTICAL CORP.
Entity type:Organization
Organization Name:KINGS PLAZA OPTICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVELINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-253-0700
Mailing Address - Street 1:5160 KINGS PLAZA MALL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5160 KINGS PLZ
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5214
Practice Address - Country:US
Practice Address - Phone:718-253-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STERLING OPTICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-18
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100091856Medicare PIN