Organization Name: | OPTICAL ILLUSIONS, INC. |
NPI Number: | 1437290756 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RAYMOND KOLKMANN (OWNER) |
Mailing Address: | 970 Broadway Thornwood |
State: | NY US |
Postal Code: | 105941139 |
Phone Number: | 9147412121 |
Fax Number: | 9147415937 |
NPI Enumeration Date: | 02/09/2007 |
NPI Last Update Date: | 07/27/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |