Provider Demographics
NPI:1932324845
Name:LRJ OPTICAL INC
Entity Type:Organization
Organization Name:LRJ OPTICAL INC
Other - Org Name:VISION PEOPLE OF BALDWIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BELFOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD OPTOMETRIST
Authorized Official - Phone:516-868-3500
Mailing Address - Street 1:939 ATLANTIC AVENUE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510
Mailing Address - Country:US
Mailing Address - Phone:516-868-3500
Mailing Address - Fax:516-868-3556
Practice Address - Street 1:939 ATLANTIC AVENUE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-868-3500
Practice Address - Fax:516-868-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0046151152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC44231Medicare UPIN
NY1081520001Medicare NSC