Provider Demographics
NPI:1568503886
Name:OPTICAL ILLUSIONS OF YORKTOWN, INC.
Entity Type:Organization
Organization Name:OPTICAL ILLUSIONS OF YORKTOWN, INC.
Other - Org Name:RAYMOND OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLKMANN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:914-245-5151
Mailing Address - Street 1:3630 HILL BLVD, SUITE 203
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1502
Mailing Address - Country:US
Mailing Address - Phone:914-245-5151
Mailing Address - Fax:914-245-7157
Practice Address - Street 1:78 BROOKSIDE AVE, SUITE 2
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-1059
Practice Address - Country:US
Practice Address - Phone:914-469-5161
Practice Address - Fax:914-469-5761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0728840001Medicare PIN