Provider Demographics
NPI:1861581704
Name:STEBI OPTICAL INC.
Entity type:Organization
Organization Name:STEBI OPTICAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DERKATCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-466-3874
Mailing Address - Street 1:146 MIDDLE NECK RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1246
Mailing Address - Country:US
Mailing Address - Phone:516-466-3874
Mailing Address - Fax:516-466-1346
Practice Address - Street 1:146 MIDDLE NECK RD
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1246
Practice Address - Country:US
Practice Address - Phone:516-466-3874
Practice Address - Fax:516-466-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004987152W00000X
NY4296156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0303500001Medicare NSC