Provider Demographics
NPI:1730501115
Name:ELIZABETH OPTICAL INC
Entity Type:Organization
Organization Name:ELIZABETH OPTICAL INC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-631-3699
Mailing Address - Street 1:21151 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2492
Mailing Address - Country:US
Mailing Address - Phone:718-631-3699
Mailing Address - Fax:718-646-1330
Practice Address - Street 1:21151 26TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2492
Practice Address - Country:US
Practice Address - Phone:718-631-3699
Practice Address - Fax:718-646-1330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-20
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies