Provider Demographics
NPI:1316097140
Name:JTP OPTICAL INC
Entity type:Organization
Organization Name:JTP OPTICAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SINOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-927-1000
Mailing Address - Street 1:1 E FORDHAM RD
Mailing Address - Street 2:SIGHT N STYLE OPTICAL
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468
Mailing Address - Country:US
Mailing Address - Phone:718-733-6700
Mailing Address - Fax:
Practice Address - Street 1:78 GRAHAM AVE
Practice Address - Street 2:SIGHT N STYLE OPTICAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206
Practice Address - Country:US
Practice Address - Phone:718-733-6700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01782750Medicaid