Provider Demographics
NPI:1699809343
Name:OPTIX OF LONG ISLAND, INC
Entity Type:Organization
Organization Name:OPTIX OF LONG ISLAND, INC
Other - Org Name:OPTIX FAMILY EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:KESTENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-931-6330
Mailing Address - Street 1:431 S OYSTER BAY RD
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3313
Mailing Address - Country:US
Mailing Address - Phone:516-931-6330
Mailing Address - Fax:
Practice Address - Street 1:431 S OYSTER BAY RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3313
Practice Address - Country:US
Practice Address - Phone:516-931-6330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT003883152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0134450001Medicare NSC
NYC73041Medicare PIN