Provider Demographics
NPI:1619574506
Name:JACKSON HEIGHTS VISION EXPRESS LLC
Entity type:Organization
Organization Name:JACKSON HEIGHTS VISION EXPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:VAYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-748-1570
Mailing Address - Street 1:3727 82ND ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7031
Mailing Address - Country:US
Mailing Address - Phone:718-458-8800
Mailing Address - Fax:718-458-9678
Practice Address - Street 1:3727 82ND ST
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7031
Practice Address - Country:US
Practice Address - Phone:718-458-8800
Practice Address - Fax:718-458-9678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-05
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty