Provider Demographics
NPI:1194094227
Name:MAIN ST. OPTICAL
Entity type:Organization
Organization Name:MAIN ST. OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:AVROHOM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-517-5459
Mailing Address - Street 1:39 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3005
Mailing Address - Country:US
Mailing Address - Phone:845-517-5459
Mailing Address - Fax:845-517-5460
Practice Address - Street 1:39 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3005
Practice Address - Country:US
Practice Address - Phone:845-517-5459
Practice Address - Fax:845-517-5460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004341-1156FX1800X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty