Provider Demographics
NPI:1720770555
Name:LUXURY VISION CENTER INC
Entity type:Organization
Organization Name:LUXURY VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRAKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-471-9505
Mailing Address - Street 1:1125 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3310
Mailing Address - Country:US
Mailing Address - Phone:917-471-9505
Mailing Address - Fax:
Practice Address - Street 1:1125 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3310
Practice Address - Country:US
Practice Address - Phone:917-471-9505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier