Provider Demographics
NPI:1245454917
Name:LENS LAB EXPRESS, INC.
Entity type:Organization
Organization Name:LENS LAB EXPRESS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SICHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-526-2332
Mailing Address - Street 1:16334 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4912
Mailing Address - Country:US
Mailing Address - Phone:718-526-2332
Mailing Address - Fax:718-297-3349
Practice Address - Street 1:16334 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4912
Practice Address - Country:US
Practice Address - Phone:718-526-2332
Practice Address - Fax:718-297-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002552-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#