Provider Demographics
NPI:1306000799
Name:J. SAUER OPTICIANS
Entity Type:Organization
Organization Name:J. SAUER OPTICIANS
Other - Org Name:CLONDON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:LONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-727-3274
Mailing Address - Street 1:312 ROANOKE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2723
Mailing Address - Country:US
Mailing Address - Phone:631-727-3274
Mailing Address - Fax:
Practice Address - Street 1:312 ROANOKE AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2723
Practice Address - Country:US
Practice Address - Phone:631-727-3274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003396156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6078840001Medicare NSC