Provider Demographics
NPI:1154589166
Name:ECHO OPHTHALMIC DISPENSING, PC
Entity type:Organization
Organization Name:ECHO OPHTHALMIC DISPENSING, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:
Authorized Official - Last Name:O'HANLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-821-8693
Mailing Address - Street 1:243 ECHO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-2324
Mailing Address - Country:US
Mailing Address - Phone:631-821-8693
Mailing Address - Fax:631-821-7761
Practice Address - Street 1:243 ECHO AVE
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-2324
Practice Address - Country:US
Practice Address - Phone:631-821-8693
Practice Address - Fax:631-821-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7538332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier