Provider Demographics
NPI:1023144730
Name:CAITLIN OPTICAL INC
Entity type:Organization
Organization Name:CAITLIN OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RISSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LIC OPTICIAN
Authorized Official - Phone:914-961-3737
Mailing Address - Street 1:2340 CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1216
Mailing Address - Country:US
Mailing Address - Phone:914-961-3737
Mailing Address - Fax:914-961-8944
Practice Address - Street 1:2340 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1216
Practice Address - Country:US
Practice Address - Phone:914-961-3737
Practice Address - Fax:914-961-8944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003544-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0932330001Medicare NSC