Provider Demographics
NPI:1427429000
Name:NEW WOODSIDE OPTICAL CORP
Entity type:Organization
Organization Name:NEW WOODSIDE OPTICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KATSEV
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-205-9760
Mailing Address - Street 1:4811 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4450
Mailing Address - Country:US
Mailing Address - Phone:718-205-9760
Mailing Address - Fax:718-205-9738
Practice Address - Street 1:4811 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4450
Practice Address - Country:US
Practice Address - Phone:718-205-9760
Practice Address - Fax:718-205-9738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty