Organization
SUPREME VISION CENTER INC
Active
Other names
Fabulous Optical
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. EDWARD BANGIYEV (OWNER/PRESIDENT)
(718) 866-1740
Entity
Organization
Contact information
Practice address
691H COOP CITY BLVD, BRONX, NY 10475-1673
(917) 642-1035
Mailing address
200 W 125TH ST, NEW YORK, NY 10027-4410
(212) 665-5051
(212) 203-0399
Taxonomy
Speciality
Code
Description
License number
State
152WV0400X
Vision Therapy Optometrist
Primary
—
—
Other
Enumeration date
08/02/2021
Last updated
01/19/2022
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