Provider Demographics
NPI:1851663918
Name:OPTICAL ACADEMY
Entity Type:Organization
Organization Name:OPTICAL ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ABEER
Authorized Official - Middle Name:
Authorized Official - Last Name:AYOUB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-607-1068
Mailing Address - Street 1:115 W 45TH ST
Mailing Address - Street 2:SUITE 504
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4005
Mailing Address - Country:US
Mailing Address - Phone:180-061-0823
Mailing Address - Fax:
Practice Address - Street 1:115 W 45TH ST
Practice Address - Street 2:SUITE 504
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4005
Practice Address - Country:US
Practice Address - Phone:180-061-0823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006888-1152W00000X
NY009212-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty