Provider Demographics
NPI:1033413505
Name:XAVIER OPTICAL, INC.
Entity Type:Organization
Organization Name:XAVIER OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:X
Authorized Official - Last Name:SART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-299-4074
Mailing Address - Street 1:218 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3041
Mailing Address - Country:US
Mailing Address - Phone:315-299-4074
Mailing Address - Fax:
Practice Address - Street 1:218 HARRISON ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3041
Practice Address - Country:US
Practice Address - Phone:315-396-0325
Practice Address - Fax:315-396-0497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-27
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03340425Medicaid