Provider Demographics
NPI:1407097983
Name:ON SITE MOBILE OPTICIANS INC
Entity Type:Organization
Organization Name:ON SITE MOBILE OPTICIANS INC
Other - Org Name:ON SIGHT OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:PORETSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-580-2020
Mailing Address - Street 1:233 UNION AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1820
Mailing Address - Country:US
Mailing Address - Phone:631-580-2020
Mailing Address - Fax:631-580-2020
Practice Address - Street 1:233 UNION AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-1820
Practice Address - Country:US
Practice Address - Phone:631-580-2020
Practice Address - Fax:631-580-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007083332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6163420001Medicare NSC