Provider Demographics
NPI:1033276506
Name:WALFRED NASSAU OPTICAL INC.
Entity Type:Organization
Organization Name:WALFRED NASSAU OPTICAL INC.
Other - Org Name:FOCAL POINT OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECT. TREAS.
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:RAPPS
Authorized Official - Suffix:
Authorized Official - Credentials:OPHTHALMIC DISPENSER
Authorized Official - Phone:516-746-3836
Mailing Address - Street 1:2453 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4710
Mailing Address - Country:US
Mailing Address - Phone:516-746-3836
Mailing Address - Fax:
Practice Address - Street 1:2453 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4710
Practice Address - Country:US
Practice Address - Phone:516-746-3836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3934332B00000X
NY3755332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0325450001Medicare NSC