MEDICARE: GRAND CENTRAL OPTICAL CO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	5216	NY
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649221268
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRAND CENTRAL OPTICAL CO INC

Provider Business Mailing Address
First Line	:	340 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10173-0002
Country	:	US
Telephone Number	:	212-599-1220
Fax Number	:	646-666-5710

Provider Business Practice Location Address
First Line	:	340 MADISON AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10173-0002
Country	:	US
Telephone Number	:	212-599-1220
Fax Number	:	646-666-5710

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. SCOTT DOUG STEIN
Credential	:	OPTICIAN
Telephone Number	:	212-599-1220

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	04/05/2023

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