Provider Demographics
NPI:1225532112
Name:PUBLIC EYE OPTICAL DISPENSARY INC
Entity Type:Organization
Organization Name:PUBLIC EYE OPTICAL DISPENSARY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:SUMMER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-453-9505
Mailing Address - Street 1:8 GREENLAWN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2926
Mailing Address - Country:US
Mailing Address - Phone:631-423-3323
Mailing Address - Fax:631-423-3324
Practice Address - Street 1:8 GREENLAWN RD STE 1
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2926
Practice Address - Country:US
Practice Address - Phone:631-423-3323
Practice Address - Fax:631-423-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009230-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty