Provider Demographics
NPI:1225168990
Name:MID-CITY OPTICIANS
Entity Type:Organization
Organization Name:MID-CITY OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:H
Authorized Official - Last Name:FOLMSBEE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:716-692-5480
Mailing Address - Street 1:968 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-3234
Mailing Address - Country:US
Mailing Address - Phone:716-692-5480
Mailing Address - Fax:716-692-4010
Practice Address - Street 1:968 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-3234
Practice Address - Country:US
Practice Address - Phone:716-692-5480
Practice Address - Fax:716-692-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003847156FC0801X, 156FX1800X
NY3847332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01759728Medicaid
NYNY3847OtherEYEMED
NYNY3847OtherEYEMED