Provider Demographics
NPI:1659849115
Name:PLC OPTICAL CORP
Entity Type:Organization
Organization Name:PLC OPTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LACORTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-602-4139
Mailing Address - Street 1:199 GOTHIC CIR
Mailing Address - Street 2:
Mailing Address - City:MANORVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11949-2622
Mailing Address - Country:US
Mailing Address - Phone:917-602-4139
Mailing Address - Fax:
Practice Address - Street 1:460 COUNTY ROAD 111 UNIT 8
Practice Address - Street 2:
Practice Address - City:MANORVILLE
Practice Address - State:NY
Practice Address - Zip Code:11949-3375
Practice Address - Country:US
Practice Address - Phone:917-602-4139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11502510OtherCAQH