Supreme Vision Center Inc

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

Legal business name

SUPREME VISION CENTER INC

Doing business as

Fabulous Optical

Practice address

691H Coop City Blvd
Bronx, NY 10475-1673

Phone

(917) 642-1035

NPI assigned

Aug 2, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Edward Bangiyev

Title

Owner/President

Phone

(718) 866-1740

Specialties & licenses 1

Addresses

Other names 1

• Fabulous Optical Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Member of 4

Organizations this organization is a member of, according to the National Provider Directory.

• Arts of Optics Corp.

  dba Fabulous Optical

  • Optometrist
  • New York, NY
  • NPI 1619456589

  Member Of

  NPD member
• Bronx Vision Center Inc.

  • Optometrist
  • Bronx, NY
  • NPI 1952641821

  Member Of

  NPD member
• Co-Op City Pharmacy, Inc

  • Pharmacist
  • Bronx, NY
  • NPI 1952685612

  Member Of

  NPD member
• Fabulous Optical Inc

  • Optician
  • Brooklyn, NY
  • NPI 1194185900

  Member Of

  NPD member

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lindsey Brooke Chan, OD

  • Corneal and Contact Management Optometrist
  • Brooklyn, NY
  • NPI 1295563146
  Medicare reassignment NPD
• Tammy Ngo, O.D.

  • Optometrist
  • New York, NY
  • NPI 1275581209
  Medicare reassignment
• Miriam Afzali

  • Hearing Instrument Specialist
  • Bronx, NY
  • NPI 1275035776
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1265106496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W 125TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100274410",
            "telephone_number": "212-665-5051",
            "fax_number": "212-203-0399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "691H COOP CITY BLVD",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104751673",
            "telephone_number": "917-642-1035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME VISION CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-02",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "BANGIYEV",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "718-866-1740",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Vision Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fabulous Optical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fabulous Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Superior Vision Center
• Supply Needs Co. Corp.
• Alan Supraner, PHD
• Supreme Medical Supplies Inc
• Supreme Pharmacy Inc. (Queen Mary Pharmacy)
• Lirose Supreme-Edouard, BS BEHAVIOR SCIENCE
• Mark Edward Surabian, ABD, ATP
• Riyana Kassim Suraka, RN
• Pallavi Surana
• Deepthisri Suresh

• Vision Therapy Optometrist in Bronx, NY
• Providers in Bronx, NY by specialty
• Vision Therapy Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.