Provider Demographics
NPI:1003982919
Name:FARBER, PAUL (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:
Last Name:FARBER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3211
Mailing Address - Country:US
Mailing Address - Phone:914-723-7392
Mailing Address - Fax:914-723-1004
Practice Address - Street 1:971 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3211
Practice Address - Country:US
Practice Address - Phone:914-723-7392
Practice Address - Fax:914-723-1004
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004916-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4024360001Medicare ID - Type Unspecified