1154589166 NPI number — ECHO OPHTHALMIC DISPENSING, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154589166 NPI number — ECHO OPHTHALMIC DISPENSING, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ECHO OPHTHALMIC DISPENSING, PC
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:
6
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:
1154589166
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
243 ECHO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUND BEACH
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11789-2324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-821-8693
Provider Business Mailing Address Fax Number:
631-821-7761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
243 ECHO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUND BEACH
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11789-2324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-821-8693
Provider Business Practice Location Address Fax Number:
631-821-7761
Provider Enumeration Date:
05/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
O'HANLON
Authorized Official First Name:
CARMEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/OPTICIAN
Authorized Official Telephone Number:
631-821-8693

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  7538 , 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)





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