Provider Demographics
NPI:1427007053
Name:WITZ OPTICAL CORP
Entity Type:Organization
Organization Name:WITZ OPTICAL CORP
Other - Org Name:DESIGNER OPTICAL OUTLET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-982-9602
Mailing Address - Street 1:2303 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3918
Mailing Address - Country:US
Mailing Address - Phone:718-982-9602
Mailing Address - Fax:718-982-9607
Practice Address - Street 1:2303 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3918
Practice Address - Country:US
Practice Address - Phone:718-982-9602
Practice Address - Fax:718-982-9607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU003858152W00000X
NY004641156FX1800X
NY006692156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6500308OtherGHI
NY76664OtherAETNA
NY6500308OtherGHI