Provider Demographics
NPI:1689766073
Name:FAMILY OPTICAL LTD
Entity Type:Organization
Organization Name:FAMILY OPTICAL LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KORNBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-421-0250
Mailing Address - Street 1:374 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3316
Mailing Address - Country:US
Mailing Address - Phone:631-421-0250
Mailing Address - Fax:631-421-0827
Practice Address - Street 1:374 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3316
Practice Address - Country:US
Practice Address - Phone:631-421-0250
Practice Address - Fax:631-421-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02243332Medicaid
NYA100018242Medicare PIN
NY0694620001Medicare NSC