1275587610 NPI number — WOODHAVEN OPTICAL CENTER

Table of content: (NPI 1275587610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275587610 NPI number — WOODHAVEN OPTICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODHAVEN OPTICAL CENTER
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:
1275587610
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8921 JAMAICA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODHAVEN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11421-2041
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-847-1946
Provider Business Mailing Address Fax Number:
718-849-7326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8921 JAMAICA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODHAVEN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11421-2041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-847-1946
Provider Business Practice Location Address Fax Number:
718-849-7326
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEITER
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OPTOMETRIST
Authorized Official Telephone Number:
718-847-1946

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  004302 , 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: 1001850000 . This is a "UFT" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: OP1079 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50580 . This is a "DAVIS VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 713 . This is a "VISION SCREENING" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 02375340 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09282 . This is a "SPECTERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1300620001 . This is a "MEDICARE (CMS)" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 333552 . This is a "NVA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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