Provider Demographics
NPI:1760554042
Name:SUTPHIN OPTOMETRY PC
Entity Type:Organization
Organization Name:SUTPHIN OPTOMETRY PC
Other - Org Name:SUTPHIN EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FARSHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIIMPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-739-8939
Mailing Address - Street 1:8914 SUTPHIN BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11435-3715
Mailing Address - Country:US
Mailing Address - Phone:718-739-8939
Mailing Address - Fax:718-739-2755
Practice Address - Street 1:8914 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11435-3715
Practice Address - Country:US
Practice Address - Phone:718-739-8939
Practice Address - Fax:718-739-2755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY76754121OtherAETNA
NYP2141131OtherOXFORD
NY76754121OtherAETNA
NYG100013193Medicare PIN
NY6794520001Medicare NSC