Provider Demographics
NPI:1093909129
Name:ROGER GUY INC.
Entity Type:Organization
Organization Name:ROGER GUY INC.
Other - Org Name:WESTTOWN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALLABAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:607-272-7775
Mailing Address - Street 1:609 W CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5255
Mailing Address - Country:US
Mailing Address - Phone:607-272-7775
Mailing Address - Fax:607-272-7776
Practice Address - Street 1:609 W CLINTON ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5255
Practice Address - Country:US
Practice Address - Phone:607-272-7775
Practice Address - Fax:607-272-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV003728152W00000X
NY5536217156FC0801X
NYC006861-1156FX1800X
NY3079156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherFEDERAL TAX ID NUMBER
NY=========OtherFEDERAL TAX ID NUMBER