Provider Demographics
NPI:1205861176
Name:AKRON OPTICAL SHOP INC.
Entity Type:Organization
Organization Name:AKRON OPTICAL SHOP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SAROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-542-2002
Mailing Address - Street 1:55 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:NY
Mailing Address - Zip Code:14001-1239
Mailing Address - Country:US
Mailing Address - Phone:716-542-2002
Mailing Address - Fax:
Practice Address - Street 1:55 MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:NY
Practice Address - Zip Code:14001-1239
Practice Address - Country:US
Practice Address - Phone:716-542-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004942152W00000X
NYT002702-1152W00000X
NYTUV005016-1152W00000X
NY006922-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000390048012OtherCOMMUNITY BLUE
NYNY6922OtherEYEMED
NY02559539Medicaid
NY25460OtherSPECTARA
NY00026880501OtherUNIVERA
NY333701OtherNVA
NY636OtherCSEA
NY000390048012OtherBCBS OF WESTERN NY
NY44765OtherDAVIS