Provider Demographics
NPI:1215102827
Name:IBMB OPTICAL CORP
Entity type:Organization
Organization Name:IBMB OPTICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-492-4353
Mailing Address - Street 1:2603 BATH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5501
Mailing Address - Country:US
Mailing Address - Phone:347-492-4353
Mailing Address - Fax:347-492-4355
Practice Address - Street 1:2603 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5501
Practice Address - Country:US
Practice Address - Phone:347-492-4353
Practice Address - Fax:347-492-4355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No305S00000XManaged Care OrganizationsPoint of Service