Provider Demographics
NPI:1508987512
Name:SUN-VET OPTICAL CENTER CORP.
Entity Type:Organization
Organization Name:SUN-VET OPTICAL CENTER CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-567-4411
Mailing Address - Street 1:5801 SUNRISE HWY
Mailing Address - Street 2:SUITE 41
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4841
Mailing Address - Country:US
Mailing Address - Phone:631-567-4411
Mailing Address - Fax:
Practice Address - Street 1:5801 SUNRISE HWY
Practice Address - Street 2:SUITE 41
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-4841
Practice Address - Country:US
Practice Address - Phone:631-567-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003374-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty