Basic Information
| Provider Information | |||||||||
| NPI: | 1851596480 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLEAR EYES OPTICAL CORP | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 665 BEDFORD AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112118018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188759000 | ||||||||
| FaxNumber: | 7186977399 | ||||||||
| Practice Location | |||||||||
| Address1: | 665 BEDFORD AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112118018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188759000 | ||||||||
| FaxNumber: | 1869773997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2007 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SANDEL | ||||||||
| AuthorizedOfficialFirstName: | PINCHUS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OPTICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7188759000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OPHTHALMIC DISPENSER | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156FX1800X | 007594 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Technician/Technologist | Optician |
ID Information
| ID | Type | State | Issuer | Description | 02370496 | 01 | NY | PINCHUS SANDEL | OTHER | 000412358473 | 01 | NY | HEALTH PLUS | OTHER | 000423463172 | 01 | NY | HEALTH PLUS GR# | OTHER | 42773 | 01 | NY | DAVIS VISION | OTHER | 01777086 | 05 | NY | MEDICAID |