Organization
BETHPAGE OPTICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL ZAVULUNOV (OWNER OPTICIAN)
(516) 433-2015
Entity
Organization
Contact information
Practice address
582 STEWART AVE, BETHPAGE, NY 11714-2702
(516) 433-2015
(516) 433-2017
Mailing address
582 STEWART AVE, BETHPAGE, NY 11714-2702
(516) 433-2015
(516) 433-2017
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
007319-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15602
SPECTERA
NY
01
—
859
VISION SCREENING
NY
01
—
919607
BLOCK VISION
NY
01
—
NY0543
EYEMED
NY
Enumeration date
01/12/2007
Last updated
08/22/2020
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