Provider Demographics
NPI:1841331576
Name:MY OPTICAL BROOKLYN INC.
Entity type:Organization
Organization Name:MY OPTICAL BROOKLYN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MARAT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHLIMOV
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-240-9401
Mailing Address - Street 1:922 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-8402
Mailing Address - Country:US
Mailing Address - Phone:718-240-9401
Mailing Address - Fax:
Practice Address - Street 1:922 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-8402
Practice Address - Country:US
Practice Address - Phone:718-240-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02859938Medicaid
NY5958070001Medicare NSC
NYW2CZT1Medicare PIN