Provider Demographics
NPI:1184872038
Name:GAYNE OPTICAL
Entity type:Organization
Organization Name:GAYNE OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-370-7040
Mailing Address - Street 1:1462 ERIE BLVD STE A204
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1039
Mailing Address - Country:US
Mailing Address - Phone:518-370-7040
Mailing Address - Fax:518-370-4030
Practice Address - Street 1:1462 ERIE BLVD STE A204
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1039
Practice Address - Country:US
Practice Address - Phone:518-370-7040
Practice Address - Fax:518-370-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-04
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008203-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02745146Medicaid
NY5771990001Medicare NSC