Provider Demographics
NPI:1073772372
Name:GRAND ISLAND OPTICAL CO. INC.
Entity Type:Organization
Organization Name:GRAND ISLAND OPTICAL CO. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MACRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-773-7653
Mailing Address - Street 1:2077 BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2060
Mailing Address - Country:US
Mailing Address - Phone:716-773-7653
Mailing Address - Fax:
Practice Address - Street 1:2077 BASELINE RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2060
Practice Address - Country:US
Practice Address - Phone:716-773-7653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003488-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0242480001Medicare NSC