Provider Demographics
NPI:1578685806
Name:ST. ALBANS OPTICS, INC.
Entity Type:Organization
Organization Name:ST. ALBANS OPTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GADDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-525-2200
Mailing Address - Street 1:20516 LINDEN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-2926
Mailing Address - Country:US
Mailing Address - Phone:718-525-2200
Mailing Address - Fax:718-525-2201
Practice Address - Street 1:20516 LINDEN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-2926
Practice Address - Country:US
Practice Address - Phone:718-525-2200
Practice Address - Fax:718-525-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195772-4152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID#