Provider Demographics
NPI:1053570523
Name:FAMILY EYE CARE OPTOMETRY PC
Entity type:Organization
Organization Name:FAMILY EYE CARE OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OLEG
Authorized Official - Middle Name:
Authorized Official - Last Name:LISITSYN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-755-0656
Mailing Address - Street 1:PO BOX 520390
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-0390
Mailing Address - Country:US
Mailing Address - Phone:718-755-0656
Mailing Address - Fax:718-969-1326
Practice Address - Street 1:332 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4058
Practice Address - Country:US
Practice Address - Phone:718-965-2545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006388152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC172A1Medicare PIN