Provider Demographics
NPI:1144315409
Name:LOGAN OPTICAL, INC
Entity type:Organization
Organization Name:LOGAN OPTICAL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ENZERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-478-3937
Mailing Address - Street 1:116 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1618
Mailing Address - Country:US
Mailing Address - Phone:315-478-3937
Mailing Address - Fax:315-472-2692
Practice Address - Street 1:116 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1618
Practice Address - Country:US
Practice Address - Phone:315-478-3937
Practice Address - Fax:315-472-2692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
NYC003601-1156FX1800X, 156FC0801X
NYTUV003556152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty