Provider Demographics
NPI:1134392525
Name:ACCENT ON EYES CORP.
Entity type:Organization
Organization Name:ACCENT ON EYES CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MIRKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-766-2800
Mailing Address - Street 1:28 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5280
Mailing Address - Country:US
Mailing Address - Phone:516-766-2800
Mailing Address - Fax:516-766-0222
Practice Address - Street 1:28 S PARK AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5280
Practice Address - Country:US
Practice Address - Phone:516-766-2800
Practice Address - Fax:516-766-0222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004817332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1134392525Medicare UPIN
NY4705220001Medicare NSC