Provider Demographics
NPI:1801997986
Name:COHEN'S FASHION OPTICAL
Entity type:Organization
Organization Name:COHEN'S FASHION OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-792-8149
Mailing Address - Street 1:340 MIRACLE MILE DR.
Mailing Address - Street 2:MARKETPLACE MALL
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-5862
Mailing Address - Country:US
Mailing Address - Phone:585-475-0250
Mailing Address - Fax:585-475-1703
Practice Address - Street 1:340 MIRACLE MILE DR.
Practice Address - Street 2:MARKETPLACE MALL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-5862
Practice Address - Country:US
Practice Address - Phone:585-475-0250
Practice Address - Fax:585-475-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008272156FX1800X
NY002871152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty