Healthcare Provider Details

I. General information

NPI: 1255560678
Provider Name (Legal Business Name): RECAP OPTICAL,CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 07/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 SUNRISE HWY STE 80
PATCHOGUE NY
11772-2290
US

IV. Provider business mailing address

499 SUNRISE HWY STE 80
PATCHOGUE NY
11772-2290
US

V. Phone/Fax

Practice location:
  • Phone: 631-289-2010
  • Fax: 631-289-2524
Mailing address:
  • Phone: 631-289-2010
  • Fax: 631-289-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberT0044211
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. CAROL A WEBER
Title or Position: MANAGER
Credential: O.D.
Phone: 631-289-2010