Provider Demographics
NPI:1598057325
Name:OPTICAL WORLD
Entity Type:Organization
Organization Name:OPTICAL WORLD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STROH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-522-1070
Mailing Address - Street 1:684 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-3915
Mailing Address - Country:US
Mailing Address - Phone:718-522-1070
Mailing Address - Fax:718-633-1094
Practice Address - Street 1:684 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11205-3915
Practice Address - Country:US
Practice Address - Phone:718-522-1070
Practice Address - Fax:718-633-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC003719-1335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00327459Medicaid