Provider Demographics
NPI:1932356920
Name:CAMPOS OPTICAL, INC.
Entity Type:Organization
Organization Name:CAMPOS OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN / PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:AAS
Authorized Official - Phone:631-944-2442
Mailing Address - Street 1:1925 BRENTWOOD RD
Mailing Address - Street 2:INSIDE COMPARE STORE
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-4624
Mailing Address - Country:US
Mailing Address - Phone:631-873-4230
Mailing Address - Fax:631-873-4229
Practice Address - Street 1:1925 BRENTWOOD RD
Practice Address - Street 2:INSIDE COMPARE STORE
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-4624
Practice Address - Country:US
Practice Address - Phone:631-873-4230
Practice Address - Fax:631-873-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT002524-1152W00000X
NYC008701-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty