1801916820 NPI number — BOBS OPTICAL INC.

Table of content: (NPI 1801916820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801916820 NPI number — BOBS OPTICAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOBS 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:
CLASSY GLASSES
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:
1801916820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
178 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAY SHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706-8318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-969-4263
Provider Business Mailing Address Fax Number:
631-969-0182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
178 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAY SHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706-8318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-969-4263
Provider Business Practice Location Address Fax Number:
631-969-0182
Provider Enumeration Date:
03/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOOS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
HARRY
Authorized Official Title or Position:
PRES. OPTICIAN
Authorized Official Telephone Number:
631-969-4263

Provider Taxonomy Codes

  • Taxonomy code: 156FX1800X , with the licence number:  007318 , 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: 157050 . This is a "COLE VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 140321 . This is a "COLE VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 914251 . This is a "BLOCK VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01975328 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117408 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com