Provider Demographics
NPI:1649221268
Name:GRAND CENTRAL OPTICAL CO INC
Entity Type:Organization
Organization Name:GRAND CENTRAL OPTICAL CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DOUG
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:212-599-1220
Mailing Address - Street 1:340 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10173-0002
Mailing Address - Country:US
Mailing Address - Phone:212-599-1220
Mailing Address - Fax:646-666-5710
Practice Address - Street 1:340 MADISON AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10173-0002
Practice Address - Country:US
Practice Address - Phone:212-599-1220
Practice Address - Fax:646-666-5710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
152W00000X
NY5216332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05816793Medicaid