Provider Demographics
NPI:1245341841
Name:HARBOR OPTICS INC
Entity type:Organization
Organization Name:HARBOR OPTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:DENARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-474-1234
Mailing Address - Street 1:11310 BEACH CHANNEL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2209
Mailing Address - Country:US
Mailing Address - Phone:718-474-1234
Mailing Address - Fax:718-945-5809
Practice Address - Street 1:11310 BEACH CHANNEL DR
Practice Address - Street 2:
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2209
Practice Address - Country:US
Practice Address - Phone:718-474-1234
Practice Address - Fax:718-945-5809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002941-1152W00000X
NYTUV004492-1152W00000X
NYTUV007296-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY50988Medicare PIN
NYG400003094Medicare PIN
NY0598380001Medicare NSC
NY50988HMedicare PIN
NYG400000520Medicare PIN
NYT97463Medicare UPIN