Organization
BROADWAY MALL VISION EXPRESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONID VAYNER (PRESIDENT)
(516) 938-0055
Entity
Organization
Contact information
Practice address
358 BROADWAY MALL, BROADWAY MALL SUITE 371A, HICKSVILLE, NY 11801-2709
(516) 938-0055
(516) 938-8667
Mailing address
358 BROADWAY MALL, BROADWAY MALL SUITE 371A, HICKSVILLE, NY 11801-2709
(516) 938-0055
(516) 938-8667
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
005761
NY
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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