Provider Demographics
NPI:1528118056
Name:CALLAHAN, BETTY
Entity type:Individual
Prefix:MS
First Name:BETTY
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COOPER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-4808
Mailing Address - Country:US
Mailing Address - Phone:516-796-8703
Mailing Address - Fax:
Practice Address - Street 1:259 WALT WHITMAN RD
Practice Address - Street 2:STERLING OPTICAL
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-4119
Practice Address - Country:US
Practice Address - Phone:631-427-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007334-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician