Organization
MEDPLAZA OPTICAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER KOVBASYUK (PRESIDENT)
(718) 332-5047
Entity
Organization
Contact information
Practice address
3065 BRIGHTON 14TH ST, BROOKLYN, NY 11235-5501
(718) 332-5047
Mailing address
3065 BRIGHTON 14TH ST, BROOKLYN, NY 11235-5501
(718) 332-5047
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
VUT006567
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02409043
—
NY
Enumeration date
06/14/2006
Last updated
11/23/2007
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