| NPI | 1265106496 |
|---|---|
| Doing Business As | FABULOUS OPTICAL |
| Entity Type | Organization |
| Authorized Contact | EDWARD BANGIYEV Owner/President 718-866-1740 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2022-01-19 |