Provider Demographics
NPI:1639201452
Name:FURZE & ACKLEY OPTICAL INC.
Entity Type:Organization
Organization Name:FURZE & ACKLEY OPTICAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND LICENSED OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ACKLEY
Authorized Official - Suffix:SR
Authorized Official - Credentials:LO
Authorized Official - Phone:203-372-4569
Mailing Address - Street 1:4270 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2306
Mailing Address - Country:US
Mailing Address - Phone:203-372-4569
Mailing Address - Fax:203-372-6550
Practice Address - Street 1:4270 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2306
Practice Address - Country:US
Practice Address - Phone:203-372-4569
Practice Address - Fax:203-372-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT152W00000X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004133625Medicaid
CT0131540001Medicare ID - Type UnspecifiedMEDICARE ID NUMBER