Provider Demographics
NPI:1790952257
Name:D & M OPTICAL INC
Entity Type:Organization
Organization Name:D & M OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
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:718-873-3161
Mailing Address - Street 1:332 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4058
Mailing Address - Country:US
Mailing Address - Phone:718-965-2545
Mailing Address - Fax:718-965-1127
Practice Address - Street 1:332 9TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4058
Practice Address - Country:US
Practice Address - Phone:718-965-2545
Practice Address - Fax:718-965-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007422156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02705273Medicaid
NY02705273Medicaid