Provider Demographics
NPI:1902881212
Name:GEORGE OPTICAL CO. INC.
Entity Type:Organization
Organization Name:GEORGE OPTICAL CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:716-282-7377
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14302-0927
Mailing Address - Country:US
Mailing Address - Phone:716-282-7377
Mailing Address - Fax:716-282-7382
Practice Address - Street 1:1523 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2209
Practice Address - Country:US
Practice Address - Phone:716-282-7377
Practice Address - Fax:716-282-7382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004400-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00026744401OtherUNIVERA
00300164001OtherBC/BS
NY4300OtherEYEMED VISION CARE
7309985OtherINDEPENDENT HEALTH
7309985OtherINDEPENDENT HEALTH