Provider Demographics
NPI:1659425650
Name:BUENAU'S OPTICIANS INC
Entity Type:Organization
Organization Name:BUENAU'S OPTICIANS INC
Other - Org Name:BUENAU'S OPTICIANS INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIANS
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BUENAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-439-7012
Mailing Address - Street 1:228 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1222
Mailing Address - Country:US
Mailing Address - Phone:518-439-7012
Mailing Address - Fax:518-691-9277
Practice Address - Street 1:228 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1222
Practice Address - Country:US
Practice Address - Phone:518-439-7012
Practice Address - Fax:518-691-9277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY 7194332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNY 7194OtherOPTICAL LICENSE
NY0144190002Medicare NSC