1437222585 NPI number — ANNETTE OPTICAL INC

Table of content: (NPI 1437222585)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437222585 NPI number — ANNETTE OPTICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNETTE OPTICAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
STERLING OPTICAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437222585
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
881 BROADWAY MALL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HICKSVILLE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11801-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-938-6006
Provider Business Mailing Address Fax Number:
516-938-6018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
881 BROADWAY MALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HICKSVILLE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11801-2712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-938-6006
Provider Business Practice Location Address Fax Number:
516-938-6018
Provider Enumeration Date:
11/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GERSHOVICH
Authorized Official First Name:
MARIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
516-938-6006

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01630157 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: A100000778 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".