Provider Demographics
NPI:1881086015
Name:EYE LAB OPTICIAN PC
Entity type:Organization
Organization Name:EYE LAB OPTICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BAHUR
Authorized Official - Middle Name:
Authorized Official - Last Name:YACOBOV
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-849-0847
Mailing Address - Street 1:8113 LEFFERTS BLVD
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1727
Mailing Address - Country:US
Mailing Address - Phone:718-849-0847
Mailing Address - Fax:718-849-0864
Practice Address - Street 1:8113 LEFFERTS BLVD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1727
Practice Address - Country:US
Practice Address - Phone:718-849-0847
Practice Address - Fax:718-849-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-25
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6538-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty