Provider Demographics
NPI:1497703789
Name:MIDWAY OPTICS LTD
Entity Type:Organization
Organization Name:MIDWAY OPTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:TERAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-593-2888
Mailing Address - Street 1:91 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3234
Mailing Address - Country:US
Mailing Address - Phone:516-593-2888
Mailing Address - Fax:
Practice Address - Street 1:91 BROADWAY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3234
Practice Address - Country:US
Practice Address - Phone:516-593-2888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01984270Medicaid