Provider Demographics
NPI:1538215363
Name:OPTICAL FACTORY
Entity type:Organization
Organization Name:OPTICAL FACTORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTACROCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-351-4900
Mailing Address - Street 1:2090B HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2613
Mailing Address - Country:US
Mailing Address - Phone:516-358-4040
Mailing Address - Fax:516-358-7465
Practice Address - Street 1:2090B HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-2613
Practice Address - Country:US
Practice Address - Phone:516-358-4040
Practice Address - Fax:516-358-7465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0131420001Medicare NSC