Provider Demographics
NPI:1871630715
Name:E.L.H. OPTICAL, INC.
Entity Type:Organization
Organization Name:E.L.H. OPTICAL, INC.
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:631-751-8200
Mailing Address - Street 1:1320 STONY BROOK RD
Mailing Address - Street 2:SUITE # 130
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-2206
Mailing Address - Country:US
Mailing Address - Phone:631-751-8200
Mailing Address - Fax:631-751-8250
Practice Address - Street 1:1320 STONY BROOK RD
Practice Address - Street 2:SUITE # 130
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2206
Practice Address - Country:US
Practice Address - Phone:631-751-8200
Practice Address - Fax:631-751-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006051156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty