Provider Demographics
NPI:1225370844
Name:REAL OPTICAL, LLC
Entity Type:Organization
Organization Name:REAL OPTICAL, LLC
Other - Org Name:COHEN'S FASHION OPTICAL #6
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-792-8149
Mailing Address - Street 1:520 8TH AVE
Mailing Address - Street 2:9TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-6507
Mailing Address - Country:US
Mailing Address - Phone:212-792-8149
Mailing Address - Fax:646-448-3327
Practice Address - Street 1:9015 QUEENS BLVD
Practice Address - Street 2:QUEENS CENTER MALL
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4900
Practice Address - Country:US
Practice Address - Phone:718-592-5200
Practice Address - Fax:718-592-7902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier