Provider Demographics
NPI:1659636546
Name:GIRGIN, YUCEL
Entity Type:Individual
Prefix:MR
First Name:YUCEL
Middle Name:
Last Name:GIRGIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8506
Mailing Address - Country:US
Mailing Address - Phone:631-666-8282
Mailing Address - Fax:
Practice Address - Street 1:627 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8506
Practice Address - Country:US
Practice Address - Phone:631-666-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-07
Last Update Date:2012-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7995156FX1201X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FX1201XEye and Vision Services ProvidersTechnician/TechnologistOptometric Assistant