=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548305881
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PMH OPTICAL INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 224 W JERICHO TPKE
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-681-2020
-----------------------------------------------------
Fax | 516-681-2410
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 W JERICHO TPKE
-----------------------------------------------------
City | SYOSSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11791-4504
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-681-2020
-----------------------------------------------------
Fax | 516-681-2410
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. MICHAEL HANS
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 516-681-2020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 006695
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------