Provider Demographics
NPI:1063933430
Name:20 20 OPTOMETRY SERVICES, PC
Entity type:Organization
Organization Name:20 20 OPTOMETRY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSUPOV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-418-0300
Mailing Address - Street 1:10231 65TH RD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1740
Mailing Address - Country:US
Mailing Address - Phone:718-418-0300
Mailing Address - Fax:718-418-0301
Practice Address - Street 1:6240 FOREST AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-1929
Practice Address - Country:US
Practice Address - Phone:718-418-0300
Practice Address - Fax:718-418-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-06
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty