Healthcare Provider Details

I. General information

NPI: 1871627679
Provider Name (Legal Business Name): RAINES OPTICAL COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 BEACH 21ST ST
FAR ROCKAWAY NY
11691-3304
US

IV. Provider business mailing address

1055 BEACH 21ST ST
FAR ROCKAWAY NY
11691-3304
US

V. Phone/Fax

Practice location:
  • Phone: 718-327-2020
  • Fax: 718-327-3429
Mailing address:
  • Phone: 718-327-2020
  • Fax: 718-327-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV-004963-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5665
License Number StateNY

VIII. Authorized Official

Name: MR. BARRY S RAINES
Title or Position: CHIEF OPERATING OFFICER
Credential: OPTICIAN (OPH DISP)
Phone: 718-327-2020