Provider Demographics
NPI:1447797717
Name:MARIE S JEAN
Entity Type:Organization
Organization Name:MARIE S JEAN
Other - Org Name:PINK OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:SYBILLE
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-671-4372
Mailing Address - Street 1:323 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-3079
Mailing Address - Country:US
Mailing Address - Phone:845-765-1255
Mailing Address - Fax:
Practice Address - Street 1:323 MAIN ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3079
Practice Address - Country:US
Practice Address - Phone:845-765-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIE S JEAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty