Provider Demographics
NPI:1114015393
Name:BINGHAMPTON OPTICAL INC
Entity Type:Organization
Organization Name:BINGHAMPTON OPTICAL INC
Other - Org Name:EYESIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WHITING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-723-8357
Mailing Address - Street 1:MOHAWK ACRES SHOPPING CENTER
Mailing Address - Street 2:BLACK RIVER BLVD
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-339-3500
Mailing Address - Fax:315-339-3500
Practice Address - Street 1:MOHAWK ACRES SHOPPING CENTER
Practice Address - Street 2:BLACK RIVER BLVD
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-339-3500
Practice Address - Fax:315-339-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0055661332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01485905Medicaid