Provider Demographics
NPI:1912391798
Name:MADISON AVENUE OPTICAL LLC
Entity Type:Organization
Organization Name:MADISON AVENUE OPTICAL LLC
Other - Org Name:JAMES TRACEY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:SINOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-230-1348
Mailing Address - Street 1:425 MADISON AVE
Mailing Address - Street 2:SUITE 1501
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1110
Mailing Address - Country:US
Mailing Address - Phone:212-230-1348
Mailing Address - Fax:212-838-6519
Practice Address - Street 1:425 MADISON AVE
Practice Address - Street 2:SUITE 1501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1110
Practice Address - Country:US
Practice Address - Phone:212-230-1348
Practice Address - Fax:212-838-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005807-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty