Bonafide Eyewear LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BONAFIDE EYEWEAR LLC

Practice address

6825 Freshpond Rd
Ridgewood, NY 11385

Phone

(718) 386-9721

NPI assigned

Apr 9, 2007

Organization subpart

No

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

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

Authorized official

Name

Mr. Alex Babayev

Title

Owner

Phone

(917) 680-1470

Specialties & licenses 2

Addresses

Other names 1

• Bonafide Eyeware Doing business as

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1720101223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6825 FRESHPOND ROAD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "11385",
            "telephone_number": "718-386-9721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6825 FRESHPOND RD",
            "city": "RIDGEWOOD",
            "state": "NY",
            "postal_code": "11385",
            "telephone_number": "718-386-9721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONAFIDE EYEWEAR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-09",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "BABAYEV",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-680-1470",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NY",
            "license": "4359",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bonafide Eyeware",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Ridgewood, NY
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 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.