Provider Demographics
NPI:1629113865
Name:MBD OPTICAL INC.
Entity Type:Organization
Organization Name:MBD OPTICAL INC.
Other - Org Name:PEARLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-681-2020
Mailing Address - Street 1:2365 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-2027
Mailing Address - Country:US
Mailing Address - Phone:516-796-3800
Mailing Address - Fax:516-796-3802
Practice Address - Street 1:2365 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-2027
Practice Address - Country:US
Practice Address - Phone:516-796-3800
Practice Address - Fax:516-796-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003981332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0876220001Medicare NSC