Provider Demographics
NPI:1386717346
Name:OLIVOS VISION CENTER
Entity type:Organization
Organization Name:OLIVOS VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLIVOS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-847-9898
Mailing Address - Street 1:11615 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2433
Mailing Address - Country:US
Mailing Address - Phone:718-847-9898
Mailing Address - Fax:718-847-9345
Practice Address - Street 1:11615 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2433
Practice Address - Country:US
Practice Address - Phone:718-847-9898
Practice Address - Fax:718-847-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6871156FX1100X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY970NOtherNATIONAL OPTICAL SERVICES
NYNY6871OtherEYE MED
NY922825 - 102282OtherBLOCK VISION
NYOV27627OtherSPECTERA
NY02687929Medicaid
NY52743OtherDAVIS VISION