104TH ST OPTICAL INC; NPI #1033278544

Contact Information

104TH ST OPTICAL INC

1884 3RD AVE
NEW YORK, NY 10029

Phone: 212-831-4733
Fax: 212-831-0141
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Eyewear Supplier	332H00000X	87	All Other Suppliers
Optometrist	152W00000X	41	Optometry

Indicates primary specialty

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NPI Profile & details for 104TH ST OPTICAL INC

NPI # 1033278544

LBN Legal business name 104TH ST OPTICAL INC

Authorized official PHILIP SINOWAY - (OWNER)

Entity Organization

Organization subpart ¹ No

Enumeration date 12/08/2006

Last updated 09/11/2025 - About 9 months ago

Identifiers

NY	Medicaid	02687667
NY	Other	59C0310	COMMUNITY PREMIER PLUS

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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104TH ST OPTICAL INC

Contact Information

Specialty

Eyewear Supplier

Optometrist

NPI Profile & details for 104TH ST OPTICAL INC

Reviews for 104TH ST OPTICAL INC