Provider Demographics
NPI:1609852185
Name:RAINES, BARRY SCOTT (OPHTHALMIC DISPENSER)
Entity Type:Individual
Prefix:MR
First Name:BARRY
Middle Name:SCOTT
Last Name:RAINES
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:572 PLANDOME RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1946
Mailing Address - Country:US
Mailing Address - Phone:516-869-5998
Mailing Address - Fax:516-869-3513
Practice Address - Street 1:572 PLANDOME RD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-1946
Practice Address - Country:US
Practice Address - Phone:516-869-5998
Practice Address - Fax:516-869-3513
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005665156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01136492Medicaid
NYA08002326Medicare ID - Type UnspecifiedNSC SUBMITTER NO
NYI00235Medicare ID - Type UnspecifiedGHI MEDICARE SUBMITTER NO