Healthcare Provider Details

I. General information

NPI: 1649221268
Provider Name (Legal Business Name): GRAND CENTRAL OPTICAL CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 MADISON AVE
NEW YORK NY
10173-0002
US

IV. Provider business mailing address

340 MADISON AVE
NEW YORK NY
10173-0002
US

V. Phone/Fax

Practice location:
  • Phone: 212-599-1220
  • Fax: 646-666-5710
Mailing address:
  • Phone: 212-599-1220
  • Fax: 646-666-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5216
License Number StateNY

VIII. Authorized Official

Name: MR. SCOTT DOUG STEIN
Title or Position: PRESIDENT
Credential: OPTICIAN
Phone: 212-599-1220