Provider Demographics
NPI:1023183381
Name:R & I OPTICAL
Entity type:Organization
Organization Name:R & I OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYTSIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-497-5470
Mailing Address - Street 1:5625 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4740
Mailing Address - Country:US
Mailing Address - Phone:718-497-5470
Mailing Address - Fax:718-386-0532
Practice Address - Street 1:5625 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4740
Practice Address - Country:US
Practice Address - Phone:718-497-5470
Practice Address - Fax:718-386-0532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0919660001152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5836OtherAVESIS
NY08694OtherSPECTERA
NY333195OtherNVA
NY01540752Medicaid
NYNY2856001OtherEYEMED
NYNY2856001OtherEYEMED