Provider Demographics
NPI:1922242957
Name:OPTICAL SHOPS OF AMERICA
Entity Type:Organization
Organization Name:OPTICAL SHOPS OF AMERICA
Other - Org Name:FACTORY EYEGLASS OUTLET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPHTHALMIC DISPENSER
Authorized Official - Phone:516-944-7161
Mailing Address - Street 1:23 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2916
Mailing Address - Country:US
Mailing Address - Phone:516-944-7161
Mailing Address - Fax:516-944-7262
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2916
Practice Address - Country:US
Practice Address - Phone:516-944-7161
Practice Address - Fax:516-944-7262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003218332900000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No332H00000XSuppliersEyewear Supplier