Provider Demographics
NPI:1902097884
Name:OPTICAL FASHIONS CORP
Entity Type:Organization
Organization Name:OPTICAL FASHIONS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED NYS OPTICIA
Authorized Official - Phone:845-896-5519
Mailing Address - Street 1:200 WESTAGE BUSINESS CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524
Mailing Address - Country:US
Mailing Address - Phone:845-896-5519
Mailing Address - Fax:845-896-5559
Practice Address - Street 1:200 WESTAGE BUSINESS CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524
Practice Address - Country:US
Practice Address - Phone:845-896-5519
Practice Address - Fax:845-896-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4535156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC70591Medicare PIN
NY0912880001Medicare NSC