Provider Demographics
NPI:1659586923
Name:86TH STREET OPTICAL INC.
Entity Type:Organization
Organization Name:86TH STREET OPTICAL INC.
Other - Org Name:COHENS FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:AMORELLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-833-2320
Mailing Address - Street 1:414 86TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209
Mailing Address - Country:US
Mailing Address - Phone:718-833-2320
Mailing Address - Fax:718-833-1194
Practice Address - Street 1:414 86TH STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:718-833-2320
Practice Address - Fax:718-833-1194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004723156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01638128Medicaid