Provider Demographics
NPI:1871631374
Name:EYEMAGINATION OPTICAL CORP
Entity Type:Organization
Organization Name:EYEMAGINATION OPTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GALINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-354-5661
Mailing Address - Street 1:1581 ROUTE 202
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2901
Mailing Address - Country:US
Mailing Address - Phone:845-354-5661
Mailing Address - Fax:
Practice Address - Street 1:1633 ROUTE 202 # STORE108
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2925
Practice Address - Country:US
Practice Address - Phone:845-354-5661
Practice Address - Fax:845-262-1545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYUV004778152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C45012Medicare PIN
0323390002Medicare NSC
U29157Medicare UPIN
NYA100080944Medicare PIN