1194037812 NPI number — EYES & OPTICS GOUV LLC

Table of content: CHERYL LYNN RAFUSE RT (NPI 1407034648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194037812 NPI number — EYES & OPTICS GOUV LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYES & OPTICS GOUV 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:
1194037812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2021
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:
227 MADISON ST
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:
10002-7537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-346-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/10/2010

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: 156F00000X , with the licence number:  C007816 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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