Provider Demographics
NPI:1396985107
Name:J. LOUIS EYECARE, LLC
Entity type:Organization
Organization Name:J. LOUIS EYECARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:CLAUDY
Authorized Official - Last Name:LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-666-2675
Mailing Address - Street 1:2922 AVENUE L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4639
Mailing Address - Country:US
Mailing Address - Phone:718-513-6911
Mailing Address - Fax:718-513-6912
Practice Address - Street 1:2618 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-5012
Practice Address - Country:US
Practice Address - Phone:212-666-2615
Practice Address - Fax:212-400-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0065541332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02290311Medicaid