Provider Demographics
NPI:1831231729
Name:CENTRAL OPTOMETRY PC
Entity type:Organization
Organization Name:CENTRAL OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATERINA
Authorized Official - Middle Name:
Authorized Official - Last Name:GINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-257-7700
Mailing Address - Street 1:1110 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-9061
Mailing Address - Country:US
Mailing Address - Phone:718-257-7700
Mailing Address - Fax:
Practice Address - Street 1:1110 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-9061
Practice Address - Country:US
Practice Address - Phone:718-257-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYW0FF11Medicare PIN