Healthcare Provider Details

I. General information

NPI: 1952352650
Provider Name (Legal Business Name): CAPTREE OPTICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 E MAIN ST
BABYLON NY
11702-3508
US

IV. Provider business mailing address

40 E MAIN ST
BABYLON NY
11702-3508
US

V. Phone/Fax

Practice location:
  • Phone: 631-587-2020
  • Fax:
Mailing address:
  • Phone: 631-587-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberC3778
License Number StateNY

VIII. Authorized Official

Name: PAUL GLASER
Title or Position: PRES
Credential:
Phone: 631-587-2020