Provider Demographics
NPI:1013036656
Name:REAL OPTICAL, LLC
Entity Type:Organization
Organization Name:REAL OPTICAL, LLC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CETTINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-729-5373
Mailing Address - Street 1:520 EIGHTH AVENUE
Mailing Address - Street 2:SUITE 901
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018
Mailing Address - Country:US
Mailing Address - Phone:212-729-5373
Mailing Address - Fax:212-967-5927
Practice Address - Street 1:ROOSEVELT FIELD MALL
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-294-0011
Practice Address - Fax:516-294-2916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#