Provider Demographics
NPI:1548452113
Name:NORTH FORK OPTICAL CENTER, LTD
Entity type:Organization
Organization Name:NORTH FORK OPTICAL CENTER, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:EILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:631-298-9555
Mailing Address - Street 1:P.O. BOX 1419
Mailing Address - Street 2:
Mailing Address - City:MATTITUCK
Mailing Address - State:NY
Mailing Address - Zip Code:11952-0995
Mailing Address - Country:US
Mailing Address - Phone:631-298-9555
Mailing Address - Fax:631-298-9556
Practice Address - Street 1:10095 MAIN RD
Practice Address - Street 2:
Practice Address - City:MATTITUCK
Practice Address - State:NY
Practice Address - Zip Code:11952-0995
Practice Address - Country:US
Practice Address - Phone:631-298-9555
Practice Address - Fax:631-298-9556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU003815332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0148920001Medicare NSC
NYC3A172Medicare PIN
NYA100018914Medicare PIN