Provider Demographics
NPI:1699957944
Name:PEN OPTICAL AND ASSOCIATES INC.
Entity type:Organization
Organization Name:PEN OPTICAL AND ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:TISCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-279-4826
Mailing Address - Street 1:450 7TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10123-0101
Mailing Address - Country:US
Mailing Address - Phone:212-279-4826
Mailing Address - Fax:212-563-3047
Practice Address - Street 1:450 7TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10123-0101
Practice Address - Country:US
Practice Address - Phone:212-279-4826
Practice Address - Fax:212-563-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0056721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO3651Medicare UPIN
NYA100067074Medicare PIN