Provider Demographics
NPI:1316156441
Name:D K OPTICAL, INC.
Entity type:Organization
Organization Name:D K OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:FALANGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-361-7310
Mailing Address - Street 1:324 SMITH HAVEN MALL
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1201
Mailing Address - Country:US
Mailing Address - Phone:631-361-7310
Mailing Address - Fax:631-361-2018
Practice Address - Street 1:324 SMITH HAVEN MALL
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1201
Practice Address - Country:US
Practice Address - Phone:631-361-7310
Practice Address - Fax:631-361-2018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003255-2302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001232Medicare PIN
NY6182820001Medicare NSC