Provider Demographics
NPI:1598960502
Name:DRESOPTICAL CORP
Entity Type:Organization
Organization Name:DRESOPTICAL CORP
Other - Org Name:SMITHTOWN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DONDIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-360-3420
Mailing Address - Street 1:2 MILLER PL
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-3608
Mailing Address - Country:US
Mailing Address - Phone:631-360-3420
Mailing Address - Fax:631-265-9006
Practice Address - Street 1:2 MILLER PL
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-3608
Practice Address - Country:US
Practice Address - Phone:631-360-3420
Practice Address - Fax:631-265-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005652152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0330580001Medicare NSC
NYU62948Medicare UPIN
NYC5W031Medicare UPIN
NYC14242Medicare PIN