Provider Demographics
NPI:1679588354
Name:ELEGANT EYEWEAR INC
Entity Type:Organization
Organization Name:ELEGANT EYEWEAR INC
Other - Org Name:SPECTACULAR EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICIAN/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:LYNNNE
Authorized Official - Last Name:FEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-822-8971
Mailing Address - Street 1:436 WOODBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3327
Mailing Address - Country:US
Mailing Address - Phone:516-822-8971
Mailing Address - Fax:516-821-8565
Practice Address - Street 1:436 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1001
Practice Address - Country:US
Practice Address - Phone:516-822-8971
Practice Address - Fax:516-822-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-007355-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5656550001Medicare NSC