Basic Information
| Provider Information | |||||||||
| NPI: | 1790837599 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LENS LAB OF REGO PARK | ||||||||
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| OtherOrganizationName: | LENS LAB EXPRESS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3073 STEINWAY ST | ||||||||
| Address2: | |||||||||
| City: | ASTORIA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111033801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186265184 | ||||||||
| FaxNumber: | 7186265405 | ||||||||
| Practice Location | |||||||||
| Address1: | 9519 63RD DR | ||||||||
| Address2: | |||||||||
| City: | REGO PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113742024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189978185 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | SHERI | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7186265184 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist |
No ID Information.