Provider Demographics
NPI:1275501694
Name:MY OPTICIAN INC.
Entity Type:Organization
Organization Name:MY OPTICIAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-495-8801
Mailing Address - Street 1:9516 CHURCH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-2434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9516 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-2434
Practice Address - Country:US
Practice Address - Phone:718-495-8801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007320156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02104543Medicaid
NY02104543Medicaid
NYCAWNF1Medicare PIN
NYA100026396Medicare PIN