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NPI Code Detail

MEDICARE: ADVANTAGE OPTIX, INC.

MEDICARE: ADVANTAGE OPTIX, 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
1332H00000XEyewear Supplier007987NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1109240OTHERNYEYE MED

General Provider Information

NPI Number : 1932237823
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANTAGE OPTIX, INC.
Provider Business Mailing Address
First Line : 1445 HEMPSTEAD TPKE
Second Line : PEARLE VISION
City : ELMONT
State : NY
Zip : 11003-2404
Country : US
Telephone Number : 516-616-1771
Fax Number : 516-616-0473
Provider Business Practice Location Address
First Line : 1445 HEMPSTEAD TPKE
Second Line : PEARLE VISION
City : ELMONT
State : NY
Zip : 11003-2404
Country : US
Telephone Number : 516-616-1771
Fax Number : 516-616-0473
Authorized Official
Title or Position : PRESIDENT
Name : MS. ALLA SLOOTSKY
Credential :
Telephone Number : 516-616-1771
Provider Enumeration Date : 03/01/2007
Last Update Date : 05/04/2012

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