Provider Demographics
NPI:1720039035
Name:OPTIGLAZ INC.
Entity Type:Organization
Organization Name:OPTIGLAZ INC.
Other - Org Name:EMPIRE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETATSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-891-6400
Mailing Address - Street 1:720 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6412
Mailing Address - Country:US
Mailing Address - Phone:718-891-6400
Mailing Address - Fax:718-891-6400
Practice Address - Street 1:720 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6412
Practice Address - Country:US
Practice Address - Phone:718-891-6400
Practice Address - Fax:718-891-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01472980Medicaid
NY01472980Medicaid
NY0752610001Medicare NSC