Provider Demographics
NPI:1659495570
Name:DREAM SIGHT OPTICAL CORP.
Entity Type:Organization
Organization Name:DREAM SIGHT OPTICAL CORP.
Other - Org Name:VISION WORLD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMEO
Authorized Official - Middle Name:V
Authorized Official - Last Name:MALOCO
Authorized Official - Suffix:JR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:631-476-4707
Mailing Address - Street 1:524 JEFFERSON PLAZA, ROUTE 112
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1104
Mailing Address - Country:US
Mailing Address - Phone:631-476-4707
Mailing Address - Fax:
Practice Address - Street 1:524 JEFFERSON PLZ
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1104
Practice Address - Country:US
Practice Address - Phone:631-476-4707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-17
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC006424-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty