Broadway Mall Vision Express, LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

005761 Issued in NY

Legal business name

BROADWAY MALL VISION EXPRESS, LLC

Practice address

358 Broadway Mall
Broadway Mall Suite 371a
Hicksville, NY 11801-2709

Phone

(516) 938-0055

Fax

(516) 938-8667

NPI assigned

Dec 13, 2016

Organization subpart

No

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

Authorized official

Name

Leonid Vayner

Title

President

Phone

(516) 938-0055

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1481587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481587200000",
    "number": "1982148763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "358 BROADWAY MALL",
            "address_2": "BROADWAY MALL SUITE 371A",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118012709",
            "telephone_number": "516-938-0055",
            "fax_number": "516-938-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 BROADWAY MALL",
            "address_2": "BROADWAY MALL SUITE 371A",
            "city": "HICKSVILLE",
            "state": "NY",
            "postal_code": "118012709",
            "telephone_number": "516-938-0055",
            "fax_number": "516-938-8667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY MALL VISION EXPRESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-13",
        "last_updated": "2016-12-13",
        "status": "A",
        "authorized_official_last_name": "VAYNER",
        "authorized_official_first_name": "LEONID",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "516-938-0055"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NY",
            "license": "005761",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Brennan
• Stacey Brites
• Broadway Mall Dental
• Broadway Mall Eye Care LLC
• Broadway Mall Optical
• Abimbola Brooks
• Nicholas Edward Broughton, PHYSICIAN ASSISTANT
• Jazmen Brown
• Ida Brownley, CRPA
• Paula Leslie Bruckner, R.N.

• Eyewear Supplier in Hicksville, NY
• Providers in Hicksville, NY by specialty
• Eyewear Supplier in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.