Provider Demographics
NPI:1346408416
Name:OPTICAL CENTER, INC.
Entity Type:Organization
Organization Name:OPTICAL CENTER, INC.
Other - Org Name:HARBOUR OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:POLIZZI
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:631-789-2525
Mailing Address - Street 1:940 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-4901
Mailing Address - Country:US
Mailing Address - Phone:631-789-2525
Mailing Address - Fax:631-789-1495
Practice Address - Street 1:940 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:COPIAGUE
Practice Address - State:NY
Practice Address - Zip Code:11726-4901
Practice Address - Country:US
Practice Address - Phone:631-789-2525
Practice Address - Fax:631-789-1495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005528152W00000X
NY003867-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100039151Medicare PIN
NY0140790001Medicare NSC