Provider Demographics
NPI:1427037092
Name:I.N.OPTICAL CORP.
Entity Type:Organization
Organization Name:I.N.OPTICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAK
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIVKER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-261-1764
Mailing Address - Street 1:11212 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6344
Mailing Address - Country:US
Mailing Address - Phone:718-261-1764
Mailing Address - Fax:718-261-1764
Practice Address - Street 1:11212 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6344
Practice Address - Country:US
Practice Address - Phone:718-261-1764
Practice Address - Fax:718-261-1764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006712-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY168520OtherEYE MED VISION CARE
NY9724462OtherGHI
NYP3871801OtherOXFORD HEALTH PLANS
NY230230OtherUNITED HEALTHCARE
NY010047901OtherAMERICHOICE
NY01788816Medicaid
NY905828OtherBLOCK VISION
2960956OtherAETNA
NYT81400Medicare UPIN
NY1206960001Medicare NSC
2960956OtherAETNA