Provider Demographics
NPI:1467403188
Name:A&L OPTICAL CORPORATION
Entity Type:Organization
Organization Name:A&L OPTICAL CORPORATION
Other - Org Name:CANARSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IZABELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUGILEV-CALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-968-8866
Mailing Address - Street 1:2108 ROCKAWAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-5802
Mailing Address - Country:US
Mailing Address - Phone:718-968-8866
Mailing Address - Fax:
Practice Address - Street 1:2108 ROCKAWAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5802
Practice Address - Country:US
Practice Address - Phone:718-968-8866
Practice Address - Fax:718-968-8855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01615076Medicaid
NY1127380001Medicare ID - Type Unspecified