Provider Demographics
NPI:1760758171
Name:REYES OPTICA INC.
Entity Type:Organization
Organization Name:REYES OPTICA INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:Y
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:917-923-0792
Mailing Address - Street 1:1571 SAINT NICHOLAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-4261
Mailing Address - Country:US
Mailing Address - Phone:212-542-3937
Mailing Address - Fax:212-543-3932
Practice Address - Street 1:1571 SAINT NICHOLAS AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-4261
Practice Address - Country:US
Practice Address - Phone:212-542-3937
Practice Address - Fax:212-543-3932
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BURNSIDE OPTICAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007379-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty