Provider Demographics
NPI:1265618326
Name:KINGSBORO VISION INC.
Entity type:Organization
Organization Name:KINGSBORO VISION INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:BASHOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-236-4477
Mailing Address - Street 1:6304 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:718-236-0113
Practice Address - Street 1:6304 18TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2937
Practice Address - Country:US
Practice Address - Phone:718-236-4477
Practice Address - Fax:718-236-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0857740001Medicare NSC