1922237866 NPI number — OLIVOS OPTICIANS INC

Table of content: (NPI 1922237866)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922237866 NPI number — OLIVOS OPTICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OLIVOS OPTICIANS 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:
1922237866
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7508 37TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON HEIGHTS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11372-6538
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-476-1458
Provider Business Mailing Address Fax Number:
718-476-1462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7508 37TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11372-6538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-476-1458
Provider Business Practice Location Address Fax Number:
718-476-1462
Provider Enumeration Date:
07/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-476-1458

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  VUT6417 , 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: 02266351 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 63132 . This is a "OPTUM HEALTH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 63179 . This is a "DAVIS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 287834 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7184761458 . This is a "VSP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A01762 . This is a "EYEMED" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1013080415 . This is a "BLOCK" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: T006417 . This is a "METROPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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