Provider Demographics
NPI:1730206319
Name:ICU OPTICAL INC.
Entity type:Organization
Organization Name:ICU OPTICAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARACINA
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:631-648-9488
Mailing Address - Street 1:601 PORTION RD STE 14
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-4584
Mailing Address - Country:US
Mailing Address - Phone:631-648-9488
Mailing Address - Fax:631-648-9487
Practice Address - Street 1:601 PORTION RD STE 14
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-4584
Practice Address - Country:US
Practice Address - Phone:631-648-9488
Practice Address - Fax:631-648-9487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier