Provider Demographics
NPI:1144682931
Name:OCEAN VIEW OPTICAL 5
Entity type:Organization
Organization Name:OCEAN VIEW OPTICAL 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANATOLIY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTHALMIC DISPENCER
Authorized Official - Phone:1718-596-6596
Mailing Address - Street 1:453 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5207
Mailing Address - Country:US
Mailing Address - Phone:718-596-6596
Mailing Address - Fax:718-596-6596
Practice Address - Street 1:453 FULTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5207
Practice Address - Country:US
Practice Address - Phone:718-596-6596
Practice Address - Fax:718-596-6596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC006785-1302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01729822Medicaid