Provider Demographics
NPI:1205286192
Name:GRAND OPTICAL,INC
Entity type:Organization
Organization Name:GRAND OPTICAL,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-741-0700
Mailing Address - Street 1:630 OLD COUNTRY RD
Mailing Address - Street 2:493/A
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-3467
Mailing Address - Country:US
Mailing Address - Phone:516-741-0700
Mailing Address - Fax:516-741-0707
Practice Address - Street 1:630 OLD COUNTRY RD
Practice Address - Street 2:493/A
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-3467
Practice Address - Country:US
Practice Address - Phone:516-741-0700
Practice Address - Fax:516-741-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005108-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty