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General NPI Number Information
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NPI Number | 1942285721
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Entity Type | Organization
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Legal Business Name | BARRY SCOTT RAINES
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Dates
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Enumeration Date | 12/14/2005
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 257 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3625
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Country | US
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Telephone | 718-327-2020
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Fax | 718-327-3429
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Provider Business Mailing Address
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Address Line | 257 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3625
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Country | US
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Telephone | 718-327-2020
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Fax | 718-327-3429
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Authorized Official
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Title or Position | OPTICIAN/OWNER
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Name | MR. BARRY SCOTT RAINES
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Credential | OPHTHALMIC DISPENSER
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Telephone | 718-327-2020
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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 | 005665
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License Number State | NY
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