Provider Demographics
NPI:1063718229
Name:P & R OPTICAL
Entity type:Organization
Organization Name:P & R OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSTOVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-587-6565
Mailing Address - Street 1:711 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4133
Mailing Address - Country:US
Mailing Address - Phone:347-587-6565
Mailing Address - Fax:347-587-6565
Practice Address - Street 1:711 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-4133
Practice Address - Country:US
Practice Address - Phone:347-587-6565
Practice Address - Fax:347-587-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-07
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC009086156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty