Provider Demographics
NPI:1548431521
Name:DESIGNER OPTICAL OF PELHAM
Entity Type:Organization
Organization Name:DESIGNER OPTICAL OF PELHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:BERTI
Authorized Official - Last Name:CHOAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-513-3577
Mailing Address - Street 1:21-96A WHITE PLAINS ROAD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462
Mailing Address - Country:US
Mailing Address - Phone:718-513-3577
Mailing Address - Fax:
Practice Address - Street 1:21-96A WHITE PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462
Practice Address - Country:US
Practice Address - Phone:718-513-3577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6254302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization