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General NPI Number Information
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NPI Number | 1346408416
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Entity Type | Organization
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Legal Business Name | OPTICAL CENTER, INC.
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 02/22/2011
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Provider Practice Location Address
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Address Line | 940 MONTAUK HWY
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City | COPIAGUE
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State | NY
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Zip | 11726-4901
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Country | US
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Telephone | 631-789-2525
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Fax | 631-789-1495
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Provider Business Mailing Address
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Address Line | 940 MONTAUK HWY
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City | COPIAGUE
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State | NY
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Zip | 11726-4901
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Country | US
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Telephone | 631-789-2525
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Fax | 631-789-1495
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Authorized Official
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Title or Position | OWNER
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Name | MR. THOMAS POLIZZI
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Credential | OPTICIAN
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Telephone | 631-789-2525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 003867-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV005528
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License Number State | NY
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