Provider Demographics
NPI:1649545492
Name:MICHELLE'S OPTICAL INC
Entity type:Organization
Organization Name:MICHELLE'S OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-321-1212
Mailing Address - Street 1:4101 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3138
Mailing Address - Country:US
Mailing Address - Phone:718-321-1212
Mailing Address - Fax:
Practice Address - Street 1:4101 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3138
Practice Address - Country:US
Practice Address - Phone:718-321-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty