Provider Demographics
NPI:1760756282
Name:MDO OPTICAL, INC
Entity Type:Organization
Organization Name:MDO OPTICAL, INC
Other - Org Name:COHEN'S FASHION OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAKSIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-542-6060
Mailing Address - Street 1:180 ROUTE 35
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2023
Mailing Address - Country:US
Mailing Address - Phone:732-542-6060
Mailing Address - Fax:732-389-0069
Practice Address - Street 1:180 ROUTE 35
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-2023
Practice Address - Country:US
Practice Address - Phone:732-542-6060
Practice Address - Fax:732-389-0069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTD3639332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier