Provider Demographics
NPI:1194992560
Name:PLATINUM OPTICAL, CORP
Entity type:Organization
Organization Name:PLATINUM OPTICAL, CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVILENSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-229-1470
Mailing Address - Street 1:20 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7501
Mailing Address - Country:US
Mailing Address - Phone:212-229-1470
Mailing Address - Fax:
Practice Address - Street 1:20 W 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7501
Practice Address - Country:US
Practice Address - Phone:212-229-1470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT0027891332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier