Provider Demographics
NPI:1922237866
Name:OLIVOS OPTICIANS INC
Entity Type:Organization
Organization Name:OLIVOS OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:718-476-1458
Mailing Address - Street 1:7508 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6538
Mailing Address - Country:US
Mailing Address - Phone:718-476-1458
Mailing Address - Fax:718-476-1462
Practice Address - Street 1:7508 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6538
Practice Address - Country:US
Practice Address - Phone:718-476-1458
Practice Address - Fax:718-476-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT6417332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02266351Medicaid
NY63132OtherOPTUM HEALTH
NY63179OtherDAVIS
NY287834OtherUNITED HEALTHCARE
NY7184761458OtherVSP
NYA01762OtherEYEMED
NY1013080415OtherBLOCK
NYT006417OtherMETROPLUS
NYT006417OtherMETROPLUS
NY6271980001Medicare PIN