Provider Demographics
NPI:1720210180
Name:ADVANCED OPTICAL,INC
Entity Type:Organization
Organization Name:ADVANCED OPTICAL,INC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEINBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-399-6992
Mailing Address - Street 1:999 MONTAUK HWY UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2100
Mailing Address - Country:US
Mailing Address - Phone:631-399-6992
Mailing Address - Fax:631-399-8045
Practice Address - Street 1:999 MONTAUK HWY UNIT 3
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2100
Practice Address - Country:US
Practice Address - Phone:631-399-6992
Practice Address - Fax:631-399-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-19
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1918051332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6351930001Medicare NSC
NYA100034007Medicare PIN