Healthcare Provider Details

I. General information

NPI: 1942285721
Provider Name (Legal Business Name): BARRY SCOTT RAINES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 BEACH 20TH ST
FAR ROCKAWAY NY
11691-3625
US

IV. Provider business mailing address

257 BEACH 20TH ST
FAR ROCKAWAY NY
11691-3625
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 Code332H00000X
TaxonomyEyewear Supplier
License Number005665
License Number StateNY

VIII. Authorized Official

Name: MR. BARRY SCOTT RAINES
Title or Position: OPTICIAN/OWNER
Credential: OPHTHALMIC DISPENSER
Phone: 718-327-2020