Organization
STARLIGHT OPTICAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANISLAV ILYUSHA (PRESIDENT)
(718) 787-4111
Entity
Organization
Contact information
Practice address
1501 GRAVESEND NECK RD, BROOKLYN, NY 11229-4434
(718) 787-4111
(718) 787-4114
Mailing address
1501 GRAVESEND NECK RD, BROOKLYN, NY 11229-4434
(718) 787-4111
(718) 787-4114
Taxonomy
Speciality
Code
Description
License number
State
152WC0802X
Corneal and Contact Management Optometrist
Primary
TUV006443
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02218697
—
NY
Enumeration date
04/26/2008
Last updated
02/04/2009
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