Provider Demographics
NPI:1700599784
Name:ADVANCED EYECARE INC
Entity type:Organization
Organization Name:ADVANCED EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:IZICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-398-2020
Mailing Address - Street 1:115 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1301
Mailing Address - Country:US
Mailing Address - Phone:718-398-2020
Mailing Address - Fax:718-230-0024
Practice Address - Street 1:115 7TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1301
Practice Address - Country:US
Practice Address - Phone:718-398-2020
Practice Address - Fax:718-230-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty