Provider Demographics
NPI:1255986972
Name:VISION QUEST OPTICAL OF STORY AVENUE INC
Entity type:Organization
Organization Name:VISION QUEST OPTICAL OF STORY AVENUE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-430-9776
Mailing Address - Street 1:1955 TURNBULL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2516
Mailing Address - Country:US
Mailing Address - Phone:718-430-9776
Mailing Address - Fax:718-684-6197
Practice Address - Street 1:1955 TURNBULL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2516
Practice Address - Country:US
Practice Address - Phone:718-430-9776
Practice Address - Fax:718-684-6197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty