Provider Demographics
NPI:1588988729
Name:NEW COLUMBIAN OPTICAL
Entity type:Organization
Organization Name:NEW COLUMBIAN OPTICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RETAIL DIRECTOR
Authorized Official - Phone:516-944-7161
Mailing Address - Street 1:325 N 72ND ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3605
Mailing Address - Country:US
Mailing Address - Phone:402-551-9541
Mailing Address - Fax:402-551-9606
Practice Address - Street 1:807 MELBOURNE RD
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4630
Practice Address - Country:US
Practice Address - Phone:817-589-2065
Practice Address - Fax:817-589-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty