Provider Demographics
NPI:1679714018
Name:KZS OPTICAL, INC.
Entity type:Organization
Organization Name:KZS OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SISKOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-357-4511
Mailing Address - Street 1:13207 14TH AVE
Mailing Address - Street 2:WHITEPOINT SHOPPING CENTER
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-2001
Mailing Address - Country:US
Mailing Address - Phone:718-357-4511
Mailing Address - Fax:718-357-4322
Practice Address - Street 1:13207 14TH AVE
Practice Address - Street 2:WHITEPOINT SHOPPING CENTER
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-2001
Practice Address - Country:US
Practice Address - Phone:718-357-4511
Practice Address - Fax:718-357-4322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007749-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier