Provider Demographics
NPI:1295826261
Name:EYE SUPPLY OF OCEANSIDE INC
Entity Type:Organization
Organization Name:EYE SUPPLY OF OCEANSIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-764-2020
Mailing Address - Street 1:3529 LONG BEACH RD
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11572-5701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3529 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-5701
Practice Address - Country:US
Practice Address - Phone:516-764-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100049472Medicare PIN
0676910001Medicare NSC