Provider Demographics
NPI:1902060007
Name:CREATIVE OPTICAL, LLC
Entity Type:Organization
Organization Name:CREATIVE OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:EWING-CHOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-788-0022
Mailing Address - Street 1:826 WASHINGTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4063
Mailing Address - Country:US
Mailing Address - Phone:315-788-0022
Mailing Address - Fax:315-788-3211
Practice Address - Street 1:6A FULLER ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607-1338
Practice Address - Country:US
Practice Address - Phone:877-788-0022
Practice Address - Fax:315-482-3030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6202110001Medicare NSC
NY6202110002Medicare NSC