Provider Demographics
NPI:1982808408
Name:QUEENS OPTICAL CENTER, INC.
Entity Type:Organization
Organization Name:QUEENS OPTICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-539-9254
Mailing Address - Street 1:4161 KISSENA BLVD
Mailing Address - Street 2:ENTRANCE ON BARCLAY AVE.
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3105
Mailing Address - Country:US
Mailing Address - Phone:718-539-9254
Mailing Address - Fax:
Practice Address - Street 1:4161 KISSENA BLVD
Practice Address - Street 2:ENTRANCE ON BARCLAY AVE.
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3105
Practice Address - Country:US
Practice Address - Phone:718-539-9254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01488480Medicaid
NY0719420001Medicare ID - Type Unspecified