Provider Demographics
NPI:1114123031
Name:EXCEL OPTICAL CORP
Entity Type:Organization
Organization Name:EXCEL OPTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:VYACHESLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKHASOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-755-0656
Mailing Address - Street 1:4348 COLDEN ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3934
Mailing Address - Country:US
Mailing Address - Phone:718-755-0656
Mailing Address - Fax:888-500-0406
Practice Address - Street 1:4348 COLDEN ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3934
Practice Address - Country:US
Practice Address - Phone:718-755-0656
Practice Address - Fax:888-500-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007973-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02942065Medicaid
NY08203Medicare PIN