Provider Demographics
NPI:1356116396
Name:ROOSEVELT OPTOMETRY ASSOCIATES PLLC
Entity type:Organization
Organization Name:ROOSEVELT OPTOMETRY ASSOCIATES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PRESIDENT/OD
Authorized Official - Prefix:DR
Authorized Official - First Name:SANAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:OORIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-269-1198
Mailing Address - Street 1:9109 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7995
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9109 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7995
Practice Address - Country:US
Practice Address - Phone:516-343-4003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty