Provider Demographics
NPI:1679637854
Name:KLY OPTICAL INC.
Entity type:Organization
Organization Name:KLY OPTICAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-567-8028
Mailing Address - Street 1:5624 8TH AVE
Mailing Address - Street 2:STORE C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3518
Mailing Address - Country:US
Mailing Address - Phone:718-567-8028
Mailing Address - Fax:718-567-7386
Practice Address - Street 1:5624 8TH AVE
Practice Address - Street 2:STORE C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-3518
Practice Address - Country:US
Practice Address - Phone:718-567-8028
Practice Address - Fax:718-567-7386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006429152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty