Provider Demographics
NPI:1134306459
Name:FEDEROPTICS CORP
Entity Type:Organization
Organization Name:FEDEROPTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DORON
Authorized Official - Middle Name:
Authorized Official - Last Name:FEDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-342-2020
Mailing Address - Street 1:125 DOLSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-6559
Mailing Address - Country:US
Mailing Address - Phone:845-342-2020
Mailing Address - Fax:845-342-5934
Practice Address - Street 1:125 DOLSON AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-6559
Practice Address - Country:US
Practice Address - Phone:845-342-2020
Practice Address - Fax:845-342-5934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0776010001Medicare NSC
NYC32491Medicare UPIN