Provider Demographics
NPI:1851175137
Name:LANCE TRISTAN ENTERPRISES, INC.
Entity Type:Organization
Organization Name:LANCE TRISTAN ENTERPRISES, INC.
Other - Org Name:AUSTIN RYAN OPTIKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FRAYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:845-636-6571
Mailing Address - Street 1:243 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-368-2202
Mailing Address - Fax:845-504-5484
Practice Address - Street 1:243 ROUTE 59
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-368-2202
Practice Address - Fax:845-504-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty