Provider Demographics
NPI:1427133289
Name:SPECIAL EYES LLC
Entity type:Organization
Organization Name:SPECIAL EYES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARANTOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-494-9257
Mailing Address - Street 1:2791 RICHMOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:718-494-9257
Mailing Address - Fax:718-494-4183
Practice Address - Street 1:2791 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-5859
Practice Address - Country:US
Practice Address - Phone:718-494-9257
Practice Address - Fax:718-494-4183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0045731152W00000X
NYC0038731156F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001177Medicare PIN
NY0149060001Medicare NSC