Provider Demographics
NPI:1912181181
Name:ARIS, KARL LEIGH (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:LEIGH
Last Name:ARIS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-3210
Mailing Address - Country:US
Mailing Address - Phone:718-639-0911
Mailing Address - Fax:718-693-0911
Practice Address - Street 1:4704 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3210
Practice Address - Country:US
Practice Address - Phone:718-639-0911
Practice Address - Fax:718-693-0911
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4517156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00483321Medicaid