Provider Demographics
NPI:1497116321
Name:ENTIRE EYE CARE INC
Entity Type:Organization
Organization Name:ENTIRE EYE CARE INC
Other - Org Name:THE LITTLE OPTICAL ON BROADWAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-575-1531
Mailing Address - Street 1:116 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-2797
Mailing Address - Country:US
Mailing Address - Phone:631-665-8105
Mailing Address - Fax:631-665-8105
Practice Address - Street 1:116 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2797
Practice Address - Country:US
Practice Address - Phone:631-665-8105
Practice Address - Fax:631-665-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-20
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY55009230152W00000X, 156FC0800X, 156FC0801X, 156FX1100X, 156FX1800X, 305S00000X, 332H00000X
NY66009230332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No305S00000XManaged Care OrganizationsPoint of Service
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty