Provider Demographics
NPI:1942482179
Name:LIMAGE OPTICAL
Entity Type:Organization
Organization Name:LIMAGE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LIMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-222-6770
Mailing Address - Street 1:355 W 125TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-4817
Mailing Address - Country:US
Mailing Address - Phone:212-222-6770
Mailing Address - Fax:212-222-6770
Practice Address - Street 1:355 W 125TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-4817
Practice Address - Country:US
Practice Address - Phone:212-222-6770
Practice Address - Fax:212-222-6770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTIN