Provider Demographics
NPI:1851637185
Name:EYELAND OPTICIANS INC
Entity Type:Organization
Organization Name:EYELAND OPTICIANS INC
Other - Org Name:NATIONAL OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKHALOV
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:516-493-9323
Mailing Address - Street 1:40 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3811
Mailing Address - Country:US
Mailing Address - Phone:516-493-9323
Mailing Address - Fax:
Practice Address - Street 1:111 HEMPSTEAD TPKE
Practice Address - Street 2:INSIDE NWL
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2155
Practice Address - Country:US
Practice Address - Phone:516-493-9323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-13
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009414-1156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03522401Medicaid