Provider Demographics
NPI:1609059906
Name:MR OPTICAL INC
Entity Type:Organization
Organization Name:MR OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MORTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGATY
Authorized Official - Suffix:
Authorized Official - Credentials:NYS OPTICIAN
Authorized Official - Phone:718-423-3937
Mailing Address - Street 1:5604 MARATHON PKWY
Mailing Address - Street 2:
Mailing Address - City:DOUGLASTON
Mailing Address - State:NY
Mailing Address - Zip Code:11362-2034
Mailing Address - Country:US
Mailing Address - Phone:718-423-3937
Mailing Address - Fax:718-423-3999
Practice Address - Street 1:5604 MARATHON PKWY
Practice Address - Street 2:
Practice Address - City:DOUGLASTON
Practice Address - State:NY
Practice Address - Zip Code:11362-2034
Practice Address - Country:US
Practice Address - Phone:718-423-3937
Practice Address - Fax:718-423-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4284332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5469690001Medicare NSC