Provider Demographics
NPI:1366541146
Name:RIDGEWOOD OPTICAL, INC.
Entity type:Organization
Organization Name:RIDGEWOOD OPTICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:ONCIU-FLOREA
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:718-821-1112
Mailing Address - Street 1:5902 CATALPA AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-4461
Mailing Address - Country:US
Mailing Address - Phone:718-821-1112
Mailing Address - Fax:
Practice Address - Street 1:5902 CATALPA AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-4461
Practice Address - Country:US
Practice Address - Phone:718-821-1112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006870156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02555824Medicaid
NY10844Medicare ID - Type Unspecified
NY02555824Medicaid
NYT31746Medicare UPIN