Provider Demographics
NPI:1205052552
Name:EYEGLASS SERVICE INDUSTRIES, INC.
Entity type:Organization
Organization Name:EYEGLASS SERVICE INDUSTRIES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPOL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:516-599-1135
Mailing Address - Street 1:469 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-3017
Mailing Address - Country:US
Mailing Address - Phone:516-599-1135
Mailing Address - Fax:516-599-4825
Practice Address - Street 1:469 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-3017
Practice Address - Country:US
Practice Address - Phone:516-599-1135
Practice Address - Fax:516-599-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002803-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherOWNER SSN#