Provider Demographics
NPI:1982618203
Name:PERRY S. MOLLICK OPTICAL
Entity Type:Organization
Organization Name:PERRY S. MOLLICK OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOLLICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-579-2233
Mailing Address - Street 1:1 CENTER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-1032
Mailing Address - Country:US
Mailing Address - Phone:516-579-2233
Mailing Address - Fax:516-579-5437
Practice Address - Street 1:1 CENTER LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-1032
Practice Address - Country:US
Practice Address - Phone:516-579-2233
Practice Address - Fax:516-579-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1251130001Medicare NSC