Provider Demographics
NPI:1467550053
Name:CANAL STREET OPTICAL, INC.
Entity Type:Organization
Organization Name:CANAL STREET OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MUI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-227-2978
Mailing Address - Street 1:158 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4501
Mailing Address - Country:US
Mailing Address - Phone:212-227-2978
Mailing Address - Fax:212-227-2971
Practice Address - Street 1:158 CANAL ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4501
Practice Address - Country:US
Practice Address - Phone:212-227-2978
Practice Address - Fax:212-227-2971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV6116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY178511POtherHIP
NY02311219Medicaid
NY43666OtherDAVIS VISION
NY178511POtherHIP
NY43666OtherDAVIS VISION