Provider Demographics
NPI:1104581032
Name:PARK AVENUE OPTOMETRY PLLC
Entity type:Organization
Organization Name:PARK AVENUE OPTOMETRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIYAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:332-345-2363
Mailing Address - Street 1:287 PARK AVE S STE 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-4573
Mailing Address - Country:US
Mailing Address - Phone:332-345-2363
Mailing Address - Fax:332-345-2364
Practice Address - Street 1:287 PARK AVE S STE 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4573
Practice Address - Country:US
Practice Address - Phone:332-345-2363
Practice Address - Fax:332-345-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty