Provider Demographics
NPI:1114515467
Name:LEGACY OPTICAL INC
Entity Type:Organization
Organization Name:LEGACY OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/NYS OPHTHALMIC DISPENSER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PFLEGER
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:631-728-3132
Mailing Address - Street 1:4 SPRINGVILLE RD STE A
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2290
Mailing Address - Country:US
Mailing Address - Phone:631-875-4544
Mailing Address - Fax:
Practice Address - Street 1:4 SPRINGVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2290
Practice Address - Country:US
Practice Address - Phone:631-875-4544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric TechnicianGroup - Multi-Specialty