Provider Demographics
NPI:1790959674
Name:PAMEL VISION AND LASER GROUP
Entity type:Organization
Organization Name:PAMEL VISION AND LASER GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARETI
Authorized Official - Middle Name:
Authorized Official - Last Name:GAZIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-779-3156
Mailing Address - Street 1:115 E 61ST ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8183
Mailing Address - Country:US
Mailing Address - Phone:212-355-2215
Mailing Address - Fax:212-355-6930
Practice Address - Street 1:2308 30TH AVE
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-3397
Practice Address - Country:US
Practice Address - Phone:718-278-3800
Practice Address - Fax:718-278-3318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAMEL VISION AND LASER GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-22
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194606207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01465567Medicaid
06213Medicare PIN
NY01465567Medicaid