Provider Demographics
NPI:1164546610
Name:OPTHALMOLOGY ASSOC OF STATIEN ISLAND DBA BRIDGE OPTICIANS
Entity Type:Organization
Organization Name:OPTHALMOLOGY ASSOC OF STATIEN ISLAND DBA BRIDGE OPTICIANS
Other - Org Name:BRIDGE OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-447-0022
Mailing Address - Street 1:1460 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3914
Mailing Address - Country:US
Mailing Address - Phone:718-876-5966
Mailing Address - Fax:718-876-6097
Practice Address - Street 1:1460 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3914
Practice Address - Country:US
Practice Address - Phone:718-876-5966
Practice Address - Fax:718-876-6097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0658870002OtherPTAN
NY0658870002OtherPTAN