Provider Demographics
NPI:1598707317
Name:MPM OPTICAL INC.
Entity Type:Organization
Organization Name:MPM OPTICAL INC.
Other - Org Name:PRECISION VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:MUSIAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-381-4577
Mailing Address - Street 1:6928 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7263
Mailing Address - Country:US
Mailing Address - Phone:718-381-4577
Mailing Address - Fax:718-634-2540
Practice Address - Street 1:6928 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7263
Practice Address - Country:US
Practice Address - Phone:718-381-4577
Practice Address - Fax:718-634-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3663OtherHEALTH PLUS
NY43631OtherDAVIS VISION
NYHIP31319OtherHIP
NY004555OtherBLOCK VISION INC.
NY01612871Medicaid
NYNY3825OtherEYEMED
NYM028443OtherSPECTERA
NY3663OtherHEALTH PLUS
NYHIP31319OtherHIP