Provider Demographics
NPI:1588865018
Name:3 EYED OPTICAL
Entity type:Organization
Organization Name:3 EYED OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FORREST
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-722-9233
Mailing Address - Street 1:3 EYED OPTICAL DBA MANHATTAN EYEWORKS
Mailing Address - Street 2:100 EAST 96 STREET, GROUND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-722-9233
Mailing Address - Fax:212-722-9208
Practice Address - Street 1:3 EYED OPTICAL DBA MANHATTAN EYEWORKS
Practice Address - Street 2:100 EAST 96 STREET, GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-722-9233
Practice Address - Fax:212-722-9208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY4780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty