Provider Demographics
NPI:1932237823
Name:ADVANTAGE OPTIX, INC.
Entity Type:Organization
Organization Name:ADVANTAGE OPTIX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLOOTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-616-1771
Mailing Address - Street 1:1445 HEMPSTEAD TPKE
Mailing Address - Street 2:PEARLE VISION
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-2404
Mailing Address - Country:US
Mailing Address - Phone:516-616-1771
Mailing Address - Fax:516-616-0473
Practice Address - Street 1:1445 HEMPSTEAD TPKE
Practice Address - Street 2:PEARLE VISION
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-2404
Practice Address - Country:US
Practice Address - Phone:516-616-1771
Practice Address - Fax:516-616-0473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007987332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY109240OtherEYE MED
NY109240OtherEYE MED