Provider Demographics
NPI:1063629483
Name:EYE SITE OPTOMETRICS
Entity Type:Organization
Organization Name:EYE SITE OPTOMETRICS
Other - Org Name:STERLING OPTICAL # 369
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNIE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-696-2020
Mailing Address - Street 1:331 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-2533
Mailing Address - Country:US
Mailing Address - Phone:631-696-2020
Mailing Address - Fax:631-696-9736
Practice Address - Street 1:331 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2533
Practice Address - Country:US
Practice Address - Phone:631-696-2020
Practice Address - Fax:631-696-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0004616152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty