Provider Demographics
NPI:1275594194
Name:SPUNKY OPTOMETRY PC
Entity Type:Organization
Organization Name:SPUNKY OPTOMETRY PC
Other - Org Name:STERLING OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:FREILICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-564-3522
Mailing Address - Street 1:1401 ROUTE 300
Mailing Address - Street 2:SUITE 1084
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-2990
Mailing Address - Country:US
Mailing Address - Phone:845-564-3522
Mailing Address - Fax:845-564-3554
Practice Address - Street 1:1401 ROUTE 300
Practice Address - Street 2:SUITE 1084
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2990
Practice Address - Country:US
Practice Address - Phone:845-564-3522
Practice Address - Fax:845-564-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-30
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005343152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01529208Medicaid
NYU38171Medicare UPIN
NYC68861Medicare ID - Type Unspecified
NY01529208Medicaid
NY5702470001Medicare NSC