Provider Demographics
NPI:1235301581
Name:GRAND SPECTACLE INC. OPTICIANS
Entity Type:Organization
Organization Name:GRAND SPECTACLE INC. OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:A
Authorized Official - Last Name:DIDONATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-424-1924
Mailing Address - Street 1:6660 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-2531
Mailing Address - Country:US
Mailing Address - Phone:718-424-1924
Mailing Address - Fax:718-424-7247
Practice Address - Street 1:6660 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-2531
Practice Address - Country:US
Practice Address - Phone:718-424-1924
Practice Address - Fax:718-424-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003969332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier