1881806917 NPI number — JACKSON HEIGHTS OPTICAL INC

Table of content: (NPI 1881806917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881806917 NPI number — JACKSON HEIGHTS OPTICAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACKSON HEIGHTS 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:
JACKSON HEIGHTS VISION CENTER
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:
1881806917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
58-27 198 STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESH MEADOWS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-224-0315
Provider Business Mailing Address Fax Number:
718-426-9748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83-25 37TH AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-426-2725
Provider Business Practice Location Address Fax Number:
718-426-9748
Provider Enumeration Date:
05/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOPE
Authorized Official First Name:
ISAIAS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-426-2725

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  VUT005856 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: TUV005864-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: TUV007098-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: TUV006744-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X , with the licence number: 006945-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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