Provider Demographics
NPI:1538341409
Name:HATZLUCHE OPTICAL
Entity type:Organization
Organization Name:HATZLUCHE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTHOMETRIST
Authorized Official - Prefix:MR
Authorized Official - First Name:DOV
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-782-0999
Mailing Address - Street 1:49 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-7215
Mailing Address - Country:US
Mailing Address - Phone:718-782-0999
Mailing Address - Fax:718-782-0389
Practice Address - Street 1:49 LEE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-7215
Practice Address - Country:US
Practice Address - Phone:718-782-0999
Practice Address - Fax:718-782-0389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01892731Medicaid