Provider Demographics
NPI:1538491188
Name:OPTICAL CONCEPTS OF ROCKLAND INC
Entity Type:Organization
Organization Name:OPTICAL CONCEPTS OF ROCKLAND INC
Other - Org Name:STERLING OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEOPOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-623-8074
Mailing Address - Street 1:164 E ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:NANUET
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2910
Mailing Address - Country:US
Mailing Address - Phone:845-623-8074
Mailing Address - Fax:845-623-4028
Practice Address - Street 1:164 E ROUTE 59
Practice Address - Street 2:
Practice Address - City:NANUET
Practice Address - State:NY
Practice Address - Zip Code:10954-2910
Practice Address - Country:US
Practice Address - Phone:845-623-8074
Practice Address - Fax:845-623-4028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
02082010OtherDATE APP WAS SUBMITTED