Provider Demographics
NPI:1194887406
Name:AUSTIN, JOSEPHINE NONYE (OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:JOSEPHINE
Middle Name:NONYE
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10525 67TH AVE
Mailing Address - Street 2:APARTMENT 1B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2161
Mailing Address - Country:US
Mailing Address - Phone:718-793-1171
Mailing Address - Fax:
Practice Address - Street 1:369 UTICA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5552
Practice Address - Country:US
Practice Address - Phone:718-771-0078
Practice Address - Fax:718-771-0071
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02823545Medicaid