Provider Demographics
NPI:1407902620
Name:BELLEROSE OPTICAL CENTER
Entity Type:Organization
Organization Name:BELLEROSE OPTICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISPENSING OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:516-437-3839
Mailing Address - Street 1:24702 JERICHO TPKE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001-4001
Mailing Address - Country:US
Mailing Address - Phone:516-437-3839
Mailing Address - Fax:516-437-3839
Practice Address - Street 1:24702 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001-4001
Practice Address - Country:US
Practice Address - Phone:516-437-3839
Practice Address - Fax:516-437-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005764-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0257850001Medicare NSC