1548449788 NPI number — LUCIEN EYES INC

Table of content: (NPI 1548449788)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548449788 NPI number — LUCIEN EYES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUCIEN EYES 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:
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:
1548449788
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 BELLPORT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLPORT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11713-2705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-286-4014
Provider Business Mailing Address Fax Number:
631-286-2070

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5 BELLPORT LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLPORT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11713-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-286-4014
Provider Business Practice Location Address Fax Number:
631-286-2070
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DENEVE
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-286-4014

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  006097TUV , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 157939 . This is a "VYTRA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NY6097 . This is a "EYE MED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7182561 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 864 . This is a "VISION SCREENING" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 163 . This is a "DAVIS CSEA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1497 . This is a "GVS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0547081490000 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 66599326 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50593 . This is a "DAVIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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