Provider Demographics
NPI:1003988916
Name:MATRIXX OPTICS LTD
Entity Type:Organization
Organization Name:MATRIXX OPTICS LTD
Other - Org Name:METROVISION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-538-3200
Mailing Address - Street 1:216 FULTON AVE # A
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3705
Mailing Address - Country:US
Mailing Address - Phone:516-538-3200
Mailing Address - Fax:
Practice Address - Street 1:216 FULTON AVE # A
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3705
Practice Address - Country:US
Practice Address - Phone:516-538-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006759152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02074495Medicaid