Provider Demographics
NPI:1538518725
Name:CENTER STAGE OPTIQUE LLC
Entity Type:Organization
Organization Name:CENTER STAGE OPTIQUE LLC
Other - Org Name:JEFF & SON OPTIQUE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FREIDUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-656-2290
Mailing Address - Street 1:175 W 90TH ST APT 9F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1215
Mailing Address - Country:US
Mailing Address - Phone:917-656-2290
Mailing Address - Fax:
Practice Address - Street 1:45 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6601
Practice Address - Country:US
Practice Address - Phone:917-656-2290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC009255332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier