Organization
OPTICAL WAREHOUSE OUTLET OF BROOKLYN INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
YURY DAVYDOV (PRESIDENT)
(718) 941-8585
Entity
Organization
Contact information
Practice address
844 FLATBUSH AVE, BROOKLYN, NY 11226-3189
(718) 941-8585
Mailing address
844 FLATBUSH AVE, BROOKLYN, NY 11226-3189
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01986263
—
NY
05
—
02385817
—
NY
Enumeration date
06/11/2006
Last updated
10/04/2012
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