1295416923 NPI number — EYESPECS INTERNATIONAL LLC

Table of content: MRS. DEBORAH MANN SARRO MPT (NPI 1851515449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295416923 NPI number — EYESPECS INTERNATIONAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EYESPECS INTERNATIONAL LLC
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:
Provider Other Organization Name Type Code:
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:
1295416923
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20 DUNTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEER PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11729-4702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-393-7732
Provider Business Mailing Address Fax Number:
833-393-7732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 DUNTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEER PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11729-4702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-393-7732
Provider Business Practice Location Address Fax Number:
833-393-7732
Provider Enumeration Date:
07/26/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HANUKASHVILI
Authorized Official First Name:
RAFAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
917-440-9696

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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