Provider Demographics
NPI:1477671394
Name:NEW AGE OPTICAL
Entity Type:Organization
Organization Name:NEW AGE OPTICAL
Other - Org Name:SITE FOR SORE EYES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RABIH
Authorized Official - Middle Name:
Authorized Official - Last Name:KANTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-676-5638
Mailing Address - Street 1:901 SUNVALLEY BLVD
Mailing Address - Street 2:110
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-5899
Mailing Address - Country:US
Mailing Address - Phone:925-676-5638
Mailing Address - Fax:
Practice Address - Street 1:901 SUNVALLEY BLVD
Practice Address - Street 2:110
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5899
Practice Address - Country:US
Practice Address - Phone:925-676-5638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD7056156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty