Individual
OLEG LISITSYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
731 LYDIG AVE, BRONX, NY 10462-2103
(718) 829-2160
(718) 829-9502
Mailing address
25 ROME AVE, STATEN ISLAND, NY 10304-4317
(718) 442-1981
(718) 265-9219
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
006388
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02207129
—
NY
01
—
12291667
12291667
NY
01
—
204824P
HIP
NY
01
—
2420108
UNITED HEATHCARE
NY
01
—
3693940
AETNA
NY
01
—
4C8453
HEALTH NET
NY
01
—
52917
DAVIS VISION
NY
01
—
7894651
AETNA PPO
NY
01
—
8127719
CIGNA
NY
01
—
9681151
GHI
NY
01
—
C172A1
BLUE CROSS/BLUE SHIELD
NY
01
—
P2806825
OXFORD
NY
Enumeration date
05/12/2006
Last updated
04/06/2021
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