Healthcare Provider Details

I. General information

NPI: 1013036656
Provider Name (Legal Business Name): REAL OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROOSEVELT FIELD MALL
GARDEN CITY NY
11530
US

IV. Provider business mailing address

520 EIGHTH AVENUE SUITE 901
NEW YORK NY
10018
US

V. Phone/Fax

Practice location:
  • Phone: 516-294-0011
  • Fax: 516-294-2916
Mailing address:
  • Phone: 212-729-5373
  • Fax: 212-967-5927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARLEEN CETTINA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 212-729-5373