Provider Demographics
NPI:1871637306
Name:USA OPTICAL LLC
Entity Type:Organization
Organization Name:USA OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-594-0751
Mailing Address - Street 1:330 W 38TH ST
Mailing Address - Street 2:#805
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-2999
Mailing Address - Country:US
Mailing Address - Phone:212-594-0751
Mailing Address - Fax:212-594-0753
Practice Address - Street 1:316 E FORDHAM RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5008
Practice Address - Country:US
Practice Address - Phone:718-733-0900
Practice Address - Fax:718-220-2416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02253794Medicaid