Provider Demographics
NPI:1891934717
Name:MMA OPTICAL INC
Entity Type:Organization
Organization Name:MMA OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSHOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-204-7733
Mailing Address - Street 1:412 HEMPSTEAD TPKE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1336
Mailing Address - Country:US
Mailing Address - Phone:516-204-7733
Mailing Address - Fax:
Practice Address - Street 1:412 HEMPSTEAD TPKE
Practice Address - Street 2:SUITE #1
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-1336
Practice Address - Country:US
Practice Address - Phone:516-204-7733
Practice Address - Fax:516-481-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies