Provider Demographics
NPI:1366778847
Name:BROADWAY EYECARE INC
Entity type:Organization
Organization Name:BROADWAY EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAYNBLUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-543-2020
Mailing Address - Street 1:5571 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-5230
Mailing Address - Country:US
Mailing Address - Phone:718-543-2020
Mailing Address - Fax:
Practice Address - Street 1:5571 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-5230
Practice Address - Country:US
Practice Address - Phone:718-543-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-19
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145655-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier