Provider Demographics
NPI:1164518577
Name:E&I OPTICAL, INC
Entity Type:Organization
Organization Name:E&I OPTICAL, INC
Other - Org Name:VISION PALACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:IGOR
Authorized Official - Middle Name:VALERY
Authorized Official - Last Name:SUPITSKIY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-998-8400
Mailing Address - Street 1:1723 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3811
Mailing Address - Country:US
Mailing Address - Phone:718-998-8400
Mailing Address - Fax:718-998-2500
Practice Address - Street 1:1723 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3811
Practice Address - Country:US
Practice Address - Phone:718-998-8400
Practice Address - Fax:718-998-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006198152W00000X
NY007691-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02491050Medicaid
NY02491050Medicaid
NYU98389Medicare UPIN
NY4952510001Medicare NSC