Provider Demographics
NPI:1861519480
Name:KARYLA OPTICAL
Entity type:Organization
Organization Name:KARYLA OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GANT
Authorized Official - Middle Name:GILBERT
Authorized Official - Last Name:SOOHOO
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICAN
Authorized Official - Phone:631-451-7760
Mailing Address - Street 1:2326 N OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2909
Mailing Address - Country:US
Mailing Address - Phone:631-451-7760
Mailing Address - Fax:631-451-7764
Practice Address - Street 1:2326 N OCEAN AVE
Practice Address - Street 2:
Practice Address - City:FARMINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:11738-2909
Practice Address - Country:US
Practice Address - Phone:631-451-7760
Practice Address - Fax:631-451-7764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5418840001Medicare ID - Type Unspecified