Provider Demographics
NPI:1467508119
Name:149TH STREET OPTICAL CO INC
Entity Type:Organization
Organization Name:149TH STREET OPTICAL CO INC
Other - Org Name:OPTICAL CITY EXPRESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HALEM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-292-9100
Mailing Address - Street 1:399 E 149 STREET
Mailing Address - Street 2:OPTICAL CITY EXPRESS
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455
Mailing Address - Country:US
Mailing Address - Phone:718-292-9500
Mailing Address - Fax:
Practice Address - Street 1:399 E 149 STREET
Practice Address - Street 2:OPTICAL CITY EXPRESS
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-292-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01561531Medicaid