Provider Demographics
NPI:1710123526
Name:AGIN, STEVEN BARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BARRY
Last Name:AGIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1373
Mailing Address - Country:US
Mailing Address - Phone:516-295-8600
Mailing Address - Fax:516-295-5630
Practice Address - Street 1:1344 BROADWAY
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1356
Practice Address - Country:US
Practice Address - Phone:516-295-8600
Practice Address - Fax:516-295-5630
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3327152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300000341Medicare PIN