1043756331 NPI number — J. LOUIS EYECARE LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043756331 NPI number — J. LOUIS EYECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J. LOUIS EYECARE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043756331
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2922 AVENUE L
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11210-4639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-513-6911
Provider Business Mailing Address Fax Number:
718-513-6912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2618 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10025-5012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-666-2615
Provider Business Practice Location Address Fax Number:
212-400-6255
Provider Enumeration Date:
01/11/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIZEL
Authorized Official First Name:
AVRAHAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRES
Authorized Official Telephone Number:
718-513-6911

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)