Provider Demographics
NPI:1437165222
Name:MAHOPAC EYEWEAR INC.
Entity Type:Organization
Organization Name:MAHOPAC EYEWEAR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-628-8788
Mailing Address - Street 1:PO BOX 959
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-0959
Mailing Address - Country:US
Mailing Address - Phone:845-628-8788
Mailing Address - Fax:845-628-9581
Practice Address - Street 1:7 MILLER ROAD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-0959
Practice Address - Country:US
Practice Address - Phone:845-628-8788
Practice Address - Fax:845-628-9581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY133954276OtherDAVIS VISION
NY133954276OtherVISION SERVICE PLAN
NY1304650001Medicare ID - Type UnspecifiedDMERC-A