Provider Demographics
NPI:1902941164
Name:COREY OPTICAL
Entity Type:Organization
Organization Name:COREY OPTICAL
Other - Org Name:SUSAN ASSAEL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:ASSAEL
Authorized Official - Suffix:
Authorized Official - Credentials:RDO
Authorized Official - Phone:510-655-5622
Mailing Address - Street 1:4171 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5175
Mailing Address - Country:US
Mailing Address - Phone:510-655-5622
Mailing Address - Fax:
Practice Address - Street 1:4171 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5175
Practice Address - Country:US
Practice Address - Phone:510-655-5622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD 4027156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty