Provider Demographics
NPI:1275889438
Name:BAYSIDE FASHION OPTICAL
Entity Type:Organization
Organization Name:BAYSIDE FASHION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DRUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-224-5500
Mailing Address - Street 1:58-47 FRANCIS LEWIS BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1698
Mailing Address - Country:US
Mailing Address - Phone:718-224-5500
Mailing Address - Fax:718-281-4634
Practice Address - Street 1:58-47 FRANCIS LEWIS BLVD.
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-1698
Practice Address - Country:US
Practice Address - Phone:718-224-5500
Practice Address - Fax:718-281-4634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BARRY L. DRUCKER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113906207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17633Medicare UPIN
NY52491AMedicare PIN