Provider Demographics
NPI:1326193509
Name:SK OPTICAL CORP
Entity Type:Organization
Organization Name:SK OPTICAL CORP
Other - Org Name:I'LL BE SEEING YOU OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:I
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-447-7483
Mailing Address - Street 1:1140 BAY ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-4937
Mailing Address - Country:US
Mailing Address - Phone:718-447-7483
Mailing Address - Fax:718-815-8063
Practice Address - Street 1:1140 BAY ST
Practice Address - Street 2:SUITE F
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-4937
Practice Address - Country:US
Practice Address - Phone:718-447-7483
Practice Address - Fax:718-815-8063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006107152W00000X
NYC3191156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02076497Medicaid
NY02076497Medicaid