Healthcare Provider Details

I. General information

NPI: 1831594860
Provider Name (Legal Business Name): DIGITAL OPTIKS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18116 HILLSIDE AVE
JAMAICA NY
11432-4852
US

IV. Provider business mailing address

9065 180TH ST
JAMAICA NY
11432-5612
US

V. Phone/Fax

Practice location:
  • Phone: 718-297-2997
  • Fax: 718-880-9849
Mailing address:
  • Phone: 718-297-2997
  • Fax: 718-880-9849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5810
License Number StateNY

VIII. Authorized Official

Name: MR. SURESH SANPAUL
Title or Position: OPTICIAN
Credential:
Phone: 718-297-2997