Provider Demographics
NPI:1497968135
Name:SAFI OPTOMETRIST PC
Entity Type:Organization
Organization Name:SAFI OPTOMETRIST PC
Other - Org Name:MONDO OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-729-7627
Mailing Address - Street 1:4160 ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-8719
Mailing Address - Country:US
Mailing Address - Phone:315-546-0393
Mailing Address - Fax:315-546-0395
Practice Address - Street 1:4160 ROUTE 31
Practice Address - Street 2:SUITE 100A
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-8719
Practice Address - Country:US
Practice Address - Phone:315-546-0393
Practice Address - Fax:315-546-0395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5985050002Medicare NSC
NYDG8085Medicare PIN
NYBA1256Medicare PIN