| NPI | 1740402205 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLEG LISITSYN Part Owner 718-829-2160 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy (Licence: NY 006388) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2021-04-14 |