Provider Demographics
NPI:1760622575
Name:WEN DREW OPTICAL CORP
Entity Type:Organization
Organization Name:WEN DREW OPTICAL CORP
Other - Org Name:ISLAND VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:FEIGELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DISPENSING OPTICIAN
Authorized Official - Phone:516-791-5300
Mailing Address - Street 1:46 W SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-1104
Mailing Address - Country:US
Mailing Address - Phone:516-791-5300
Mailing Address - Fax:516-791-5391
Practice Address - Street 1:46 W SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1104
Practice Address - Country:US
Practice Address - Phone:516-791-5300
Practice Address - Fax:516-791-5391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4632332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
0781060001Medicare NSC