Provider Demographics
NPI:1265514541
Name:J S G OPTOMETRY PC
Entity type:Organization
Organization Name:J S G OPTOMETRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:516-354-4242
Mailing Address - Street 1:918 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3637
Mailing Address - Country:US
Mailing Address - Phone:516-354-4242
Mailing Address - Fax:516-354-4242
Practice Address - Street 1:918 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3637
Practice Address - Country:US
Practice Address - Phone:516-354-4242
Practice Address - Fax:516-354-4242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02601756Medicaid
NYV08550Medicare UPIN
NYC441E1Medicare ID - Type Unspecified
NYCCWER1Medicare PIN
NY02601756Medicaid