Provider Demographics
NPI:1063603900
Name:LENS LAB EXPRESS
Entity type:Organization
Organization Name:LENS LAB EXPRESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SICHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-224-6778
Mailing Address - Street 1:163-34 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-4912
Mailing Address - Country:US
Mailing Address - Phone:718-526-2332
Mailing Address - Fax:
Practice Address - Street 1:163-34 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4912
Practice Address - Country:US
Practice Address - Phone:718-526-2332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01521237Medicaid