Provider Demographics
NPI:1386972164
Name:EYE MAX INC.
Entity type:Organization
Organization Name:EYE MAX INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN-EYEWEAR SUPPLIER-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN-OPHTHALMIC
Authorized Official - Phone:516-352-2316
Mailing Address - Street 1:1562 UNION TPK
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-352-2316
Mailing Address - Fax:516-352-4568
Practice Address - Street 1:1562 UNION TPK
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-352-2316
Practice Address - Fax:516-352-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-07
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005042332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1080240001Medicare NSC