Provider Demographics
NPI:1437965217
Name:MICHAEL ALEXANDER OPTICAL BOUTIQUE CORP
Entity type:Organization
Organization Name:MICHAEL ALEXANDER OPTICAL BOUTIQUE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ARGELYS
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-315-1887
Mailing Address - Street 1:2124 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-3655
Mailing Address - Country:US
Mailing Address - Phone:914-315-1887
Mailing Address - Fax:
Practice Address - Street 1:2124 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-3655
Practice Address - Country:US
Practice Address - Phone:914-315-1887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty